Abstract
Between April 1977 and December 2010, a total of 574 patients underwent resection. The incidence of major hepatectomies has increased, and limited resections, including central hepatectomies and bile duct resections, were rarely performed. Combined vascular resection was being utilized more often. Operative time has become shorter, and intraoperative blood loss has also decreased significantly. Due to refinements in surgical techniques and perioperative management, morbidity has decreased significantly, but was still high. Mortality has also decreased significantly (P<0.001), from 11.1% (=8/72) before 1990 to 1.4% (=3/218) in the last 5 years. The survival for the 574 study patients (including all deaths) was 32.5% at year 5. The survival was significantly better in the later period of 2001-2010 than in the earlier period of 1977-2000 (38.1% vs. 23.1% at year 5, P<0.001). For pM0, R0, and pN0 patients (n=243), the survival in the later period was good with 67.1% at year 5. For pM0, R0, and pN1 patients (n=142), however, the survival in the later period was similar to that in the earlier period (22.1% vs. 14.6% at year 5, P=0.647). Surgical treatment for perihilar cholangiocarcinoma has been evolving steadily, with expanded surgical indication, decreased mortality, and increased survival. Survival for R0 and pN0 patients was satisfactory, while that for pN1 patients was still poor, suggesting that establishment of effective adjuvant chemotherapy is needed.
