PROXIMAL CHOLANGIOCARCINOMA - A MULTIDISCIPLINARY APPROACH

Objective: To evaluate our diagnosis and treatment of proximal cholang iocarcinoma. Design: Retrospective clinical study. Setting: Department of Surgery, University Hospital. Subjects: 66 patients with proximal cholangiocarcinoma [median age (range): 64 years (28-87)]. Interventio ns: Ultrasonography (n = 65), computed tomography (n = 55), endoscopic retrograde cholangiopancreaticography [ERCP] (n = 54), percutaneous t ranshepatic cholangiography [PTC] (n = 32), angiography (n = 19) and c ytology (n = 13) were used in diagnosis. Treatment consisted of: inser tion of a stent (n = 37), resection of the tumour (n = 16), and biliar y-enteric anastomosis (n = 9). Twenty-eight patients received radiothe rapy, 3 patients received no active treatment. Main outcome measures: Usefulness of diagnostic methods, survival. Results: Ultrasonography, ERCP and PTC were helpful whereas computed tomography, angiography, an d cytology added little additional information. Mean (SEM) survival af ter resection was 35.8 months (7.4) and after conservative treatment 1 0.4 months (1.5) (p < 0.001). Conclusion: A multidisciplinary approach is necessary and the tumour should be resected if possible.