Management of hilar cholangiocarcinoma - Comparison of an American and a Japanese experience

Objective To compare the experience and outcome in the management of hilar cholangioc arcinoma at one American and one Japanese medical center. Summary Background Data Controversies surround the issues of extent of resection for hilar cholangi ocarcinoma and whether the histopathology of such cancers are similar betwe en patients treated in America and in Japan. Methods Records were reviewed of 100 patients treated between 1980 and 1995 at the Lahey Clinic in the United States, and of 155 patients treated between 1977 and 1995 at Nagoya University Hospital in Japan. Selected pathologic slide s of resected cancers were exchanged between the two institutions and revie wed for diagnostic concordance. Results In the Lahey cohort, there were 25 resections, 53 cases of surgical explora tion with biliary bypass or intubation, and 22 cases of percutaneous transh epatic biliary drainage or endoscopic biliary drainage without surgery. In the Nagoya cohort, the respective figures were 122, 10, and 23. The overall 5-year survival rate of all patients treated (surgical and nonsurgical) du ring the study periods was 7% in the Lahey cohort and 16% in the Nagoya coh ort. The overall 10-year survival rates were 0% and 12%, respectively. In p atients who underwent resection with negative margins, the 5- and 10-year s urvival rates were 43% and 0% for the Lahey cohort and 25% and 18% for the Nagoya cohort. The surgical death rate for patients undergoing resection wa s 4% for Lahey patients and 8% for Nagoya patients. Of the patients who und erwent resection, en bloc caudate lobectomy was performed in 8% of the Lahe y patients and 89% of the Nagoya patients. Histopathologic examination of r esected cancers showed that the Nagoya patients had a higher stage of disea se than the Lahey patients. Conclusions In both Lahey and Nagoya patients, survival was most favorable when resecti on of hilar cholangiocarcinoma was accomplished with margin-negative resect ions. Combined bile duct and liver resection with caudate lobectomy contrib uted to a higher margin-negative resection rate in the Nagoya cohort.