Abstracts
1997 Digestive Disease Week

Results of resection for hilar cholangiocarcinoma: American versus Asian experience.

JI Tsao*, Y Nimura+, JW Braasch*, J Dugan§, N Hayakawa+, J Kamiya+, S Kondo+, M Nagino+, M Kanai+. Departments of *General Surgery and §Pathology, Lahey Hitchcock Clinic, Burlington, MA, and the +First Department of Surgery, Nagoya University School of Medicine, Nagoya, Japan.

Cholangiocarcinoma involving the hepatic hilum is notorious for locoregional extension and surgical inaccesibility. Most Western series have reported low resectability and low overall survival rates. Recently, better results have been reported by our Asian colleagues. This study compares the experiences with management of hilar cholangiocarcinoma at two institutions, one American and one Japanese. Data was obtained by retrospective review at the Lahey Clinic, and by retrospective analysis of a prospectively gathered database at the University of Nagoya.

                                        Lahey           Nagoya
Period of study                        1980-95         1977-95
Patients seen, (n)                         106             154
Patients resected, (n)                      25             122
      negative margin                        8             100
      positive margin                       17              22
Bile duct resection alone, (n)              21              13
Combined liver resection, (n)                4             109
Operative mortality, %                       4               8
Operative morbidity, %                      44              51
5-yr survival, %
       negative margin                      25              24
       positive margin                      19               0
*Overall 5-yr survival, %                    6              17
*survival among all patients seen with hilar cholangiocarcinoma

Summary: Survival rates are the same for patients resected with negative margins whether in the US or Japan. However, a significantly higher resectability rate contributed to a higher overall survival rate among Japanese cohorts. Conclusion: More liberal use of combined liver and bile duct resection significantly increases the rate of margin-negative resections and is currently the only way to surgically improve the overall survival rate of patients with hilar cholangiocarcinoma.