Surgical treatment and outcomes in carcinoma of the extrahepatic bile ducts - The University of Rochester experience

Hypothesis: To our knowledge, few individual surgeons and only a handful of institutions have gained a meaningful experience with the treatment of ade nocarcinoma of the extrahepatic bile ducts or cholangiocarcinoma. The purpo se of this study was to critically evaluate the experience of a single cent er in the treatment of these tumors. Design: Retrospective cohort study with a median follow-up of 48 months. Setting: Department of surgery at a university referral center. Patients: Seventy-seven patients with biopsyconfirmed adenocarcinoma of the extrahepatic bile ducts evaluated and treated between January 1980 and Feb ruary 1998. Main Outcome Measures: Prognostic variables, resectability rates, morbidity , and survival. Results: Thirty-eight male and 39 female patients were studied (median age, 71 years). Twenty-three patients (30%) underwent curative resections, 32 p atients (41%) underwent palliative surgery, and 22 patients (29%) received nonoperative therapies. The 30-day perioperative morbidity rate was 18%, an d mortality was 6%. Overall median survival was II months; 4 months for pat ients receiving nonoperative therapy; 8 months for patients recieving palli ative surgery; and 72 months for curative resection. Five-year survival rat es were 23%, 0% 10%, and 55%, respectively. Curative resection was the only prognostic variable to have a statistically significant effect on survival . Conclusions: Curative resection could be achieved in approximately one thir d of patients who had cholangiocarcinoma, and should be the goal of treatme nt. Survival is significantly improved in those patients who are considered to have resectable tumors and who undergo removal of all gross disease. Pa lliative surgical treatments also revealed a survival advantage over nonope rative therapies.