Factors associated with survival in patients operated on for hilar cholangiocarcinoma with curative intention

Cir Cir. 2019;87(5):508-515. doi: 10.24875/CIRU.19000603.

Abstract

Objective: To determine the long-term survival and to analyze the factors associated with it in the patients operated on for hilar cholangiocarcinoma (HC) with curative intention.

Method: Non concurrent cohort study. We included all patients who underwent surgery with curative intent for HC between 2002 and 2016. An analysis of factors associated with survival using Kaplan Meier, log-rank test and Cox regression was performed. A p-value less than 0.05 was considered significant.

Results: Thirty patients were operated on. The median age was 65.5 years (range: 33-84); 24 patients (80%) were male. The surgical margin was negative in 27 patients (90%). Twenty-one patients (70%) presented complications and three patients (10%) died postoperatively. Survival at the year, 5 years and 10 years were 65.7%, 37.3% and 16.6%, respectively. In multivariable analysis, the only factor associated with survival was the T stage (hazard ratio: 0.309; 95% confidence interval: 0.101-0.942; p = 0.03).

Discussion: Patients operated on for HC with curative intent in our center have adequate long-term survival, with high postoperative morbidity and mortality. The only factor that was associated with survival was T stage.

Objetivo: Determinar la sobrevida a largo plazo y analizar los factores asociados a esta en pacientes operados por colangiocarcinoma hiliar (CH) con intención curativa.

Método: Estudio de cohorte no concurrente. Se incluyeron todos los pacientes sometidos a cirugía con intención curativa por CH entre 2002 y 2016. Se realizó un análisis de los factores asociados a la sobrevida mediante Kaplan Meier, test de log-rank y regresión de Cox. Se consideró significativo un valor de p < 0.05.

Resultados: Se operaron 30 pacientes. La mediana de edad fue de 65.5 años (rango: 33-84); 24 (80%) fueron de sexo masculino. El margen quirúrgico resultó negativo en 27 (90%) pacientes. Veintiún (70%) pacientes presentaron complicaciones y 3 (10%) fallecieron en el posoperatorio. Las sobrevidas al año, a 5 años y a 10 años fueron del 65.7%, el 37.3% y el 16.6%, respectivamente. En el análisis multivariable, el único factor asociado a la sobrevida fue el estadio T (hazard ratio: 0.309; intervalo de confianza del 95%: 0.101-0.942; p = 0.03).

Discusión: Los pacientes operados por CH con intención curativa en nuestro centro presentan una adecuada sobrevida a largo plazo, con una elevada morbimortalidad posoperatoria. El único factor que se asoció a la sobrevida fue el estadio T.

Keywords: Cirugía; Klatskin tumor; Sobrevida; Surgery; Survival; Tumor de Klatskin.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery*
  • Bile Duct Neoplasms / therapy
  • Chemotherapy, Adjuvant
  • Cholangiopancreatography, Endoscopic Retrograde
  • Combined Modality Therapy
  • Drainage
  • Female
  • Hepatectomy*
  • Humans
  • Kaplan-Meier Estimate
  • Klatskin Tumor / mortality
  • Klatskin Tumor / pathology
  • Klatskin Tumor / surgery*
  • Klatskin Tumor / therapy
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Staging
  • Postoperative Complications / mortality
  • Radiotherapy, Adjuvant
  • Risk Factors
  • Treatment Outcome
  • Tumor Burden
  • Vascular Surgical Procedures