Low rate of active treatment of patients with hilar cholangiocarcinoma

• Published in: Annals of the Royal College of Surgeons of England Vol. 95; no. 5; pp. 349 - 352
• Main Authors: Mishreki, A P, Lim, E, Cranefield, P, Pascoe, S, Jackson, S, Stell, D A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2013; Royal College of Surgeons
• Subjects: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bile; Bile Duct Neoplasms - drug therapy; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - surgery; Biopsy; Cancer therapies; Chemotherapy; Cholangiocarcinoma; Cholangiocarcinoma - drug therapy; Cholangiocarcinoma - surgery; Combined Modality Therapy; Endoscopy; Female; Hospitals; HPB; Humans; Length of Stay; Male; Middle Aged; Neoplasm Recurrence, Local - etiology; Palliative Care; Patients; Stents; Surgery
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588413X13629960046598

The results of surgical resection and palliative chemotherapy use in hilar cholangiocarcinoma (HC) have been well publicised but the proportion of patients able to undergo these treatments and the comparative outcomes in a population of patients with HC are less well known. Patients with HC were identified by review of all patients undergoing percutaneous cholangiography over a nine-year period (2002-2010) in a tertiary facility. The treatment undertaken and outcomes were recorded. Overall, 68 patients were identified (37 female) with a median age of 70 years. Forty-five (66%) were treated solely by insertion of a metal stent (median survival 4.73 months) and nine (13%) also received palliative chemotherapy (median survival 13.7 months). Persisting jaundice after stent insertion was noted in 18 of 35 patients (51%) tested within one month of death. Fourteen patients (21%) underwent surgical resection (median survival 20.2 months). Patients undergoing surgical resection had significantly longer survival than those receiving only a palliative stent but not compared with those also receiving palliative chemotherapy, with short-term follow-up. Only a third of patients, however, receive active treatment (surgery or chemotherapy) and improvements in long-term biliary palliation are needed.