Changing trends of surgical treatment of hilar bile duct cancer: Clinical and experimental perspectives

Table 1 Surgical treatment of cases of hilar bile duct carcinoma 1986-1999 in this hospital)

Treatment	No. of patients	%
Resection	106	67.5
Radical resection	59	37.6
Biliary drainage	51	32.5
Total	157	100.0

Table 2 T-staging of hilar bile duct cancer (Blumgart)

T1	No vessel involvement or liver atrophy
T2	With ipsolateral liver atrophy
	No portal vein involvement
T3	With ipsolateral portal vein involvement
	With or without associated liver atrophy
	No main portal vein involvement
T4	Any of the followings
	Bilateral 2nd order hepatic duct involvement
	Main portal vein involvement

Table 3 Resectability of bile duct cancer in China (a nationwide survey, 1978-1988)

Location	No.patients	No.resected	%
Proximal	422	44	10.0
Middle	179	41	22.9
Lower	147	50	34.0
Total	748	135	18.0

Table 4 Biliary drainage and postoperative cholangitis in HBD cancer

Operation	No. of patients	No cholangitis (%)	Recurrent cholangitis (%)
Resection	59	74.6	25.4
Intern.drain.	11	36.4	63.3
Extern.drain.	21	52.4	47.6

Table 5 Tumor-free long-term survivals after radical resection of hilar bile duct carcinoma

Case	Sex	Age	Type	Histology	Operation	Follow-up
1	M	47	Nodular	Tubular Ca	B-D resection, lobectomy	6 yr 3 mo
2	F	50	Papillary	Papillary Ca	B-D resection	7 yr 2 mo
3	M	63	Nodular	Well dif.	B-D resection, Lt lobectomy	7 yr 10 mo
4	M	53	Nodular	Well dif.	B-D resection	8 yr 3 mo

B-D: bile duct; Ca: adenocarcinoma; Well dif.: well differentiated

Table 6 Survival rate of surgical treatment of hilar bile duct cancer (The General Hospital of PLA series, 1997)

Operation	n	1 yr (%)	2 (yrs)	3 (yrs)	5 (yrs)
Radical re	30	29 (96.7)	12 (40.0)	7 (23.3)	4 (13.3)
Palliative re	26	16 (21.5)	2 (7.7)	1 (3.8)	0
Int. drainage	11	5 (45.5)	0	0	0
Ext. drainage	23	6 (26.1)	0	0	0

re: resection

Table 7 Survival rate after resection of hilar bile duct cancer (reported series)

Author	n	Rx (%)	Mortality rate (%)	Survival rate(%)
				1 yr	3 yrs	5 yrs
Pinson (1962-1983)[18]	156	16.0	4.0	84	44	36
Bismuth (1969-1990)[19]	122	18.9	0	87	25
Tsuzuki (1973-1986)[21]	50	50.0	4.0	80	29	19
Cameron (1973-1989)[20]	96	40.6	2.6	70	27	11
Hadjis (1977-1985)[29]	131	20.6	7.4	70	26	22
Nimura (1977-1993)[28]	127	64.6	6.1	84	50	31
Boerma (1980-1989)*[30]	581	32.4	15.4	61	28	17
Zhou, Huang (1986-1996)[23]	103	34.9	0	96.7	23.3	13.3

Rx: radical resection; ^*:collected series

Table 8 Neural infiltration index and median survival time

Differentiation of tumor cells	PNI*	Median survival time (mos)
Papillary	0.31 ± 0.12	32
High	0.39 ± 0.18	13.5
Moderate	0.74 ± 0.39	10.8
Low	0.85 ± 0.41	7.2

* PNI > 7.0: severe nerve infiltration

Table 9 Expression of NCAM and tumor differentiation

Cell type	NCAM Expression
	(-)	(+)
Papillary	5	3
High diff.	10	12
Moderate diff.	8	16
Low diff.	3	21

P = 0.0267, χ² = 9.20