OUTCOMES AFTER CURATIVE RESECTIONS OF CHOLANGIOCARCINOMA

Objectives: To elucidate the clinical and pathologic features of extra hepatic cholangiocarcinomas and to identify prognostic variables in pa tients treated surgically. Design: Retrospective review of clinical re cords of patients undergoing surgical exploration for cholangiocarcino ma, with univariate and multivariate analyses of the clinical and path ologic factors that influenced patient survival. Setting: Mayo Clinic, Rochester, Minn. Study Participants: One hundred seventy-one patients undergoing operative intervention for diagnostic, palliative, or cura tive reasons between 1976 and 1985. Follow-up was complete until death or for a minimum of 5 years for surviving patients. Intervention: A c urative surgical resection was performed in 29% of patients, while the remainder underwent tumor biopsy or a palliative procedure. Main Outc ome Measure: Patient survival following operative treatment. Results: The operative mortality in this patient cohort was 5% and median survi val was 13 months. Overall 5-year survival was 16%, with 44% of patien ts having a curative resection still alive at 5 years. Using univariat e analysis, curative resection, tumor stage, Eastern Cooperative Oncol ogy Group performance status, total bilirubin concentration, lymph nod e status, liver invasion, tumor morphology, tumor grade, and site of t umor origin were significant determinants of prognosis. Using the Cox proportional hazards model for multivariate analysis, curative resecti on, Eastern Cooperative Oncology Group performance status, total bilir ubin concentration, and tumor grade were the only variables predictive of patient outcome. A curative resection of a proximal cholangiocarci noma had a similar chance of providing long-term survival as a curativ e distal ductal resection. Conclusions: Although the tumor extent and the patient's overall health will affect outcome, curative resection f or cholangiocarcinoma at all sites should be undertaken since this tre atment offers the best chance for long-term survival.