OBJECTIVE: To summarize the experience in diagnosis and surgical treatment of hepatic cholangiocarcinoma.
METHODS: Clinical features, diagnosis, surgical treatment and prognosis of 52 patients with hepatic cholangiocarcinoma treated at our hospital from 1993 to 2001 were retrospectively reviewed.
RESULTS: The patients with hepatic cholangiocarcinoma accounted for 4.1% (52/1261) of the total patients with primary liver carcinoma encountered at this hospital. The ratio of male to female was 1.36∶1 in this group. Some patients were complicated by hepatitis B (32.7%), hepatolith (34.6%), liver abscess (13.5%), cirrhosis (53.8%), and serum positivity for alpha-fetaprotein (21.2%). No typical clinical manifestations were present in all patients. The diagnostic rates of ultrasound examination and CT were 80.8% and 94.2%, respectively. The resection rate of hepatic cholangiocarcinoma was 48.1%; and the 1-, 3-, 5-year survival rates were 48.1% (25/52), 30.8% (16/52), and 19.2% (10/52) respectively in this group. In resectable cases, the 1-, 3-, 5-year survival rates were 80.0% (20/25), 48.0% (12/25), 28.0% (7/25) respectively. Seven patients without cirrhosis who had received radical resection and intra-arterial chemotherapy survived for more than 5 years. In unresectable 27 cases, only 5 survived over one year even if selective hepatic arterial embolism and perfusion chemotherapy were employed.
CONCLUSIONS: No specific serum marker is found for hepatic cholangiocarcinoma. CT diagnosis is superior to ultrasonography. When a patient has already diagnosed as having hepatolith or liver abscess before operation and occupying lesion is seen intraoperatively, rapid pathological examination should be done for a fair judgement of the nature of the mass and a decision-making of operative protocol. The patient can survive well after curative resection. No matter whether hepatic cholangiocarcinoma is resectable or not, both selective hepatic arterial embolism and perfusion chemotherapy are valuable.