To investigate the clinical prognosis and surgical approach in patients with different stages of hilar cholangiocarcinoma (HCCA).

Clinical data of 171 HCCA patients undergoing radical surgery in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 1, 2003 to February 28, 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 104 patients were male and 67 female, aged from 28 to 82 years with a median age of 60 years. All patients were divided into the 2003-2013 group (early period group, n=69) and 2014-2019 group (later period group, n=102), according to the issue time of Guidelines of Diagnosis and Treatments for HCCA in China. The survival prognosis and changes of surgical approaches in different periods were analyzed. Survival analysis was performed by Log-rank test. The resection rate was statistically compared by Chi-square test.

In the early period group, the median survival time was 11.0 months, and the 1-, 3-year cumulative survival rates were 43.5% and 13.0%, significantly worse than 20.0 months, 66.5% and 25.6% in the later period group (χ²=8.552, P<0.05). In the early period group, the median survival of patients without lymph node metastasis was 11.5 months, and the 1-, 3-year cumulative survival rates were 46.2% and 17.9%, and were 28.0 months, 75.1% and 34.1% in the later period group, which was significantly better than those in early period group (χ²=6.787, P<0.05). In the later period group, the resection rates of right hemihepatectomy and combined caudate lobectomy were 22%(23/102) and 41%(42/102), significantly higher than 10%(7/69) and 23%(16/69) in the early period group (χ²=4.378, 5.942; P<0.05). The R0 resection rate in the later period group was 67%(68/102), significantly higher than 45%(31/69) in the early period group (χ²=7.979, P<0.05).

Since 2014, extensive radical resection, such as right hemi-hepatectomy combined with caudate lobectomy, has been used a lot for HCCA in our center. The long-term survival of patients has been significantly raised.