Changing trends in surgical outcomes after major hepatobiliary resection for hilar cholangiocarcinoma: a single-center experience over 25 years

Background/Purpose: Hepatobiliary resection (HBR) for hilar cholangiocarcinoma (HCCa) remains a technically demanding procedure and is still associated with significant rates of morbidity and mortality. The aim of this study was to characterize changes in surgical outcomes following major HBR for HCCa at a single center over a 25-year period. Methods: Between 1980 and 2004, 126 patients undergoing preoperative biliary drainage, portal vein embolization, and major HBR were enrolled in this study. The patients were divided into two groups according to the chronological treatment period; i.e., patients who underwent surgery during the initial 20-year period (1980-1999; early group [EG]) and those who underwent surgery during the most recent 5-year period (2000-2004; late group [LG]). Clinicopathological variables were compared retrospectively between the two groups. Results: The mortality rate improved from 7.9% in the EG to 0% in the LG, but this difference did not reach the level of statistical significance (P = 0.058). The overall survival rate at 1, 3, and 5 years was 82.4%, 43.9%, and 35.2%, respectively. The overall survival rate was similar in the two groups (P = 0.153). Morbidity was documented in 57.1% of all the patients, and was comparable in the two groups (P = 0.471), but the rate of major morbidity was significantly higher in the EG (P = 0.031). Red blood cell and fresh frozen plasma transfusion requirements were significantly reduced in the LG, both in regard to the number of patients and the amount of blood product administered. The mean length of postoperative hospital stay was significantly reduced, from 74.4 + -56.3 days in the EG to 29.0 + -11.8 days in the LG (P < 0.001). Sixty-nine patients (54.8%) had stage III or IV disease (according to the General rules for surgical and pathological studies on cancer of the biliary tract of the Japanese Society of Biliary Surgery), and 55 patients (43.7%) showed positive surgical margins. There were no differences between the two groups in terms of surgical margins or pathological staging. Concluions: Improvements were documented in rates of major morbidity, length of hospital stay, and the mortality rate in the LG when compared with the EG. The overall survival rate was similar in the two groups. Blood transfusion requirements were significantly reduced in the LG when compared with the EG. However, the high proportion of patients with positive surgical margins remains a significant problem.