A single center experience with extrahepatic cholangio carcinomas

Background. Few large Western series on cholangiocarcinoma have been report ed in the literature. M, reviewed 40 consecutive cases of extrahepatic chol angiocarcinomas referred to a single center. Methods. From 1992 until 2000, 40 patients with extrahepatic cholangiocarci nomas were evaluated. The charts of all patients were reviewed to evaluate predictors Of survival. Survival was calculated with the Kaplan-Meier metho d. Results. Forty patients were referred for management of extrahepatic cholan giocarcinomas. Tumors were located in the distal common duct in 3 (7.5%), m id duct in 5 (12.5%), and at the bifurcation in 32 (80%). Surgical resectio n was attempted in 32 (80%) patients and was curative in 9 (22.5%), palliat ive in 11 (27.5%), and diagnostic in 12 (30%). Mean survival for rill patie nts was 21.1 +/- 5.1 months and on the basis of tumor stage was 71.4 +/- 15 .4, 39.7 +/- 10.6, 19.2 +/- 2.9, 3.9 +/- 1.8, and 6.9 +/- 1.3 months for st ages I, II, III, IVA, and IVB, respectively. Mean survival was 51.1 +/- 13. 5 months versus 10 +/- 1.8 months in those with curative and noncurative re sections, respectively. The presence of a portal mass was associated with a reduction in mean survival from 28.4 +/- 7.2 months to 6.0 +/- 1.9 months. Conclusions. Extrahepatic cholangiocarcinoma remains a dismal disease with only a 22.5% chance of a curative surgical resection, achieving a 5-year su rvival rate of 44.4%. Only the absence of a portal mass was predictive of a possible curative resection and long-term survival.