Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma - a single center experience

Background. Hilar resection, especially in combination with liver resection , results in substantial morbidity and mortality, which clearly influences the overall outcome. In the present study, patients who underwent resection of a proximal bile duct tumor were analyzed with the aim of identifying ri sk factors for morbidity and mortality. Methods. Between 1983 and 1998, 112 consecutive patients underwent a focal resection, which in 32 patients was combined with a hemihepatectomy (11 ext ended resections). Eighty-four percent of the patients underwent preoperati ve (endoscopic) drainage. For evaluation of different treatment strategies during the study, the period was divided in three 5-year intervals. Results. Postoperative complications occurred in 65% of the patients. The o verall hospital mortality was 15 % for focal resections and 25 % for hemihe patectomies. There was a significantly lower morbidity and no mortality aft er hilar resection during the last 5 years. A higher Bismuth classification showed significant correlation with postoperative morbidity. Extended live r resections and vascular resections and a preoperative albumin level below 35 g/L were found to be significant predictors of increased mortality in u nivariate analysis. Conclusions. The overall morbidity and mortality rate in this series is hig her than most recently published series. More (extended) fiver resections r esulted in an increased rate of microscopic tumor-free resections, at the c ost of higher hospital morbidity and mortality. Improved preoperative work- ups will result in a selection of patients who might benefit from these ext ensive resections.