HEPATIC RESECTION AND TRANSPLANTATION FOR PERIPHERAL CHOLANGIOCARCINOMA

Background: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peri pheral choIangiocarcinoma (Ch-Ca). Study Design: We reviewed our exper ience with,Ch-Ca to determine survival rates, recurrence patterns, and risk factors in 54 patients who underwent either hepatic resection or OLT between 1981 and 1994. Liver transplantation was performed in pat ients with unresectable tumors (n = 12) and in those with advanced cir rhosis (n = 8). There were 33 women (61%) and 21 men (39%), with a mea n age of 54.3 years. The median followup period was 6.8 years. Prognos tic risk factors were analyzed by univariate and multivariate analyses . Results: Mortality within 30 days was 7.4%. Overall patient and tumo r-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 yea rs, and 26% and 27% at 5 years after operation. Thirty-two patients (5 9.3%) experienced tumor recurrence. Univariate analysis revealed that multiple tumors, bilobar tumor distribution, regional lymph node invol vement, presence of metastasis, positive surgical margins, and advance d pTNM stages were significant negative predictors of both tumor-free and patient survival. Multivariate analysis revealed that positive mar gins, multiple tumors, and lymph node involvement were independently a ssociated with poor prognosis. When patients with these three negative predictors were excluded, the patient survivals at 1, 3, and 5 years were 74%, 64%, and 62%, respectively. Conclusions: Both hepatic resect ion and OLT are effective therapies for Ch-Ca when the tumor can be re moved with adequate margins, the lesion is singular, and lymph nodes a re not involved. (C) 1997 by the American College of Surgeons).