To investigate the surgical treatments and prognostics influencing factors for hilar cholangiocarcinoma.

Clinical data of 389 patients with hilar cholangiocarcinoma who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2003 and December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 208 cases were male and 181 were female, aged (59±12) years old on average. Twenty-two cases were combined with cholangitis, 5 with intrahepatic biliary calculi and 7 with cholecystolithiasis. The treatment methods and curative effects were analyzed. The rates were compared by Chi-square test. The survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Radical resection was performed in 132 cases, palliative resection in 134 cases and palliative jaundice reduction in 123 cases. The radical resection rate and combined hemihepatectomy rate was respectively 56%(104/187) and 31%(58/187) between 2008 and 2013, significantly higher than 35%(28/79) and 6%(5/79) between 2003 and 2007 (χ²=9.04, 18.73; P<0.05). Among the patients with combined hemihepatectomy, the incidence of hepatic insufficiency in the preoperative jaundice reduction group was 26%(6/23), significantly lower than 45%(18/40) in the non-jaundice reduction group (χ²=4.58, P<0.05). The incidence of biliary tract infection in the preoperative jaundice reduction group was 35%(8/23), significantly higher than 8%(3/40) in the non-jaundice reduction group (χ²=7.54, P<0.05). Among the patients with palliative jaundice reduction treatment, the incidence of cholangitis in the ERCP group was 38%(16/42), significantly higher than 14%(10/71) in the percutaneous transhepatic biliary drainage (PTBD) group (χ²=8.59, P<0.05). The postoperative 1, 2, 3-year overall survival rate was respectively 72%, 40%, 23% in the patients with simple radical resection, and was correspongdingly 81%, 46% and 31% in the patients with combined hemihepatectomy, and significant difference was observed in the overall survival rate between two groups (χ²=4.68, P<0.05). The TNM stage, residual tumor cells at incisal margin and lymph node metastasis were correlated with the prognosis of patients with radical resection (χ²=24.66, 80.31, 57.81; P<0.05).

Radical resection rate of hilar cholangiocarcinoma has been increased in recent years. Preoperative jaundice reduction can reduce incidence of hepatic insufficiency in patients with combined hemihepatectomy. Compared with PTBD, ERCP palliative jaundice reduction has the advantage of lower biliary tract infection rate. The survival rate of patients with combined hemihepatectomy is better than that of patients with simple radical resection.