“Natural History” of Unresected Cholangiocarcinoma: Patient Outcome After Noncurative Intervention

doi:10.4065/70.5.425

Mayo Clinic Proceedings

Volume 70, Issue 5, May 1995, Pages 425-429

https://doi.org/10.4065/70.5.425 Get rights and content

Objective

To clarify the “natural history” of unresected cholangiocarcinoma.

Design

We reviewed the outcome in 103 patients with biopsy-proven cholangiocarcinoma managed at our institution during a 5-year period (1980 through 1984) who did not undergo curative resection.

Material and Methods

The study group of 56 men and 47 women had initial manifestations of jaundice (71 %), abdominal pain (49 %), and weight loss (44 %). The histopathologic features were confirmed by operation in 73 patients, percutaneous biopsy in 16, endoscopy in 3, or autopsy in 11. The primary tumor site was the common hepatic duct in 270/0, the hepatic bifurcation in 27%, the common bile duct in 26%, the liver in 13%, and the right or left hepatic duct in 6%. Biopsy-proven metastatic lesions were identified in 70 patients, including 18 with proven nodal involvement. Surgical intervention (N = 57) most commonly consisted of biliary decompression (26%), biliary bypass (16%), or cholecystectomy (11 %).

Results

The operative mortality was 4% (N = 2). The hospital mortality of medically managed patients was 12%. The survival after the onset of symptoms was 53% at 1 year, 19% at 2 years, and 9% at 3 years. Only four patients (4%) lived more than 5 years. Univariate analysis of all hospitalized patients (N = 90) revealed a survival advantage for women, patients 62 years of age or younger, those with blood group A or O, surgical patients, patients who did not require biliary decompression, and those who received further palliative treatment after any type of biliary decompression. Multivariate analysis showed a survival advantage for patients who underwent surgical exploration and those who had further palliative treatment after either operative or percutaneous biliary decompression.

Conclusion

Unresected cholangiocarcinoma is a rapidly fatal process, but early intervention affects the course of the disease and likely prolongs patient survival.

Section snippets

Patients and Methods

From 1980 to 1984, 125 patients with biopsy-proven cholangiocarcinoma were managed at the Mayo Clinic. Of these 125 patients, 22 were excluded from our current analysis because they underwent potentially curative resections. Thus, we examined the outcome of 103 patients with unresected cholangiocarcinoma. The diagnosis of cholangiocarcinoma was based on histologic criteria, as described elsewhere,⁷ and the exclusion of extrabiliary adenocarcinomas. All patients underwent noncurative

Results

The study group consisted of 56 men and 47 women, who ranged from 20 to 96 years of age (mean ± standard deviation [SD], 62 ± 16). The mean duration (±SD) of symptoms before examination at our institution was 160 ± 226 days. Initial manifestations were jaundice (71%) abdominal pain (490/0), weight loss (44%), fatigue (32%), anorexia (15%), and fever (12%). The medical history was remarkable for moderate consumption of alcohol and use of tobacco in many patients (Table 1). Remote or recent

Discussion

We attempted to provide further elucidation of the outcome of patients with unresected (most commonly, unresectable) cholangiocarcinoma in our study. Our major findings, although not unexpected, were that overall survival is poor and that some patients may benefit by longer duration of survival through palliative surgical or nonoperative biliary decompression. The overall survival of our 103 patients with unresected cholangiocarcinoma after the onset of symptoms was poor; 1-,2-, and 3-year

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“Natural History” of Unresected Cholangiocarcinoma: Patient Outcome After Noncurative Intervention

Objective

Design

Material and Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

Am J Med

Am J Surg

Surgical management of 552 carcinomas of the extrahepalic bile ducts (gallbladder and periampullary tumors excluded): results of the French Surgical Association Survey

Ann Surg

Proximal bile duct cancer: quality of survival

Ann Surg

Management of proximal cholangiocarcinomas by surgical resection and radiotherapy

Am J Surg

Current management of hilar cholangiocarcinoma

Surg Gynecol Obstet