Treatment of cholangiocarcinoma: Retrospective analysis of a single-center experience.

Abstract

376 Background: Cholangiocarcinomas (CC) are relatively rare neoplasms, but they show a rising incidence worldwide. CC orginate from epithelial cells lining the intra- and extrahepatic biliary tract including the gallbladder. Methods: We retrospectively evaluated 105 patients with CC treated in our centre between 2000 and 2010. This collective consisted of 45 women (42,9 %) and 60 men (57,1 %). The median age was 64 years (33 – 87 years). 23 % of the patients were adipose, 22 % were diabetic and 23 % suffered from neoplasms different from CC. Symptoms of patients at initial diagnosis of CC were: 47 % weight loss, 39 % upper abdominal pain, 36 % jaundice. Imaging diagnostics consisted of ultrasonography, endosonography, computertomography and eRCP. Tumormarkers as CA19-9 and CEA were elevated in 76 % and 48 % of patients with CC, respectively. Localization of CC: 46 % hilus (Klatskintumor), 23 % distal choledochal truct, 20 % intrahepatic, 11 % gallbladder. Results: For 57 patients (54,3 %) primary curative surgery of the CC was considered. 13/57 showed at laparoscopy inoperability. 3/48 patients treated with palliative chemotherapy showed regression of CC, allowing surgery. Thus, 47/105 (45 %) underwent curative surgery of CC. Surgical results: 39/47 (83 %) R0-resection, 7/47 (15 %) R1-resection, 1/47 Rx-resection. Median recidive – free survival for patients with R0-resection was 14,4 months, for R1-resection 1,8 months. The mean survival time of CC patients undergone curative surgery was 22 months, that of patients with palliative chemotherapy 5 months. 1 – 3 and 5 year survival for curatively resected CC patients were 78 %, 39 % and 21 %, respectively. Palliative chemotherapeutic treatment caused 26 %, 2,5 % and 0 %, respectively. In the whole collective, median survival under chemotherapy (mainly gemcitabine) was 9 months, with best supportive care 2,5 months. Conclusions: Resection of CC is treatment of choice in localized neoplasms. In advanced CC chemotherapy mainly based on gemcitabine was superior to best supportive care.