To compare the experience and outcome in the management of hilar cholangioc
arcinoma at one American and one Japanese medical center.
Summary Background Data
Controversies surround the issues of extent of resection for hilar cholangi
ocarcinoma and whether the histopathology of such cancers are similar betwe
en patients treated in America and in Japan.
Records were reviewed of 100 patients treated between 1980 and 1995 at the
Lahey Clinic in the United States, and of 155 patients treated between 1977
and 1995 at Nagoya University Hospital in Japan. Selected pathologic slide
s of resected cancers were exchanged between the two institutions and revie
wed for diagnostic concordance.
In the Lahey cohort, there were 25 resections, 53 cases of surgical explora
tion with biliary bypass or intubation, and 22 cases of percutaneous transh
epatic biliary drainage or endoscopic biliary drainage without surgery. In
the Nagoya cohort, the respective figures were 122, 10, and 23. The overall
5-year survival rate of all patients treated (surgical and nonsurgical) du
ring the study periods was 7% in the Lahey cohort and 16% in the Nagoya coh
ort. The overall 10-year survival rates were 0% and 12%, respectively. In p
atients who underwent resection with negative margins, the 5- and 10-year s
urvival rates were 43% and 0% for the Lahey cohort and 25% and 18% for the
Nagoya cohort. The surgical death rate for patients undergoing resection wa
s 4% for Lahey patients and 8% for Nagoya patients. Of the patients who und
erwent resection, en bloc caudate lobectomy was performed in 8% of the Lahe
y patients and 89% of the Nagoya patients. Histopathologic examination of r
esected cancers showed that the Nagoya patients had a higher stage of disea
se than the Lahey patients.
In both Lahey and Nagoya patients, survival was most favorable when resecti
on of hilar cholangiocarcinoma was accomplished with margin-negative resect
ions. Combined bile duct and liver resection with caudate lobectomy contrib
uted to a higher margin-negative resection rate in the Nagoya cohort.