Clinical experience in 126 patients with tissue-proved proximal cholangiocarcinoma.

The diagnosis and treatment of 126 consecutive patients with tissue-proved cholangiocarcinoma which originates in or proximal to the common hepatic duct was reviewed. They are further divided into the hilar type and peripheral type tumours. The clinical presentations were commonly compatible with the hilar type tumour. However, the accurate pre-operative diagnosis of the peripheral type tumour was difficult because of the frequent association with hepatolithiasis (43.3%) and the high prevalence of hepatocellular carcinoma (HCC) in Taiwan; 25% of these patients underwent surgery for chronic cholangitis and 12.5% for HCC rather than cholangiocarcinoma. Among the 40 (31.7%) patients who had tumour resections, 24 were hilar type and 16 were peripheral type. There were no operative deaths and the mean survival time was 36.1 months (27.9 months for the hilar types, 52.2 months for the peripheral types). Sixty-three (50%) patients with hilar type tumours were only suitable for palliative procedures to relieve the jaundice. The 30-day mortality rate was 50 and 33.3% for the patients who received non-surgical and surgical drainages, but zero for the patients who had surgical bypasses. All the bypass patients experienced > 50% decrease of serum bilirubin, but this effect was obtained in less than half the patients receiving drainage procedures. Surgical resection significantly prolonged the survival (resection vs palliation vs no treatment = 36.1 vs 6.6 vs 3.6 months, P < 0.05), but no survival advantage was achieved in any of the palliative therapies. Five cases with tumour resection survived > 5 years. We conclude that surgical resection offers the best prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)