Skip to main content
Top
Published in: Annals of Surgical Oncology 12/2006

01-12-2006

Hepatectomy for Peripheral Cholangiocarcinoma in Elderly Patients

Authors: Chun-Nan Yeh, MD, Yi-Yin Jan, MD, FACS, Miin-Fu Chen, MD, FACS

Published in: Annals of Surgical Oncology | Issue 12/2006

Login to get access

Abstract

Background

Peripheral cholangiocarcinoma (CCC) is less common than hepatocellular carcinoma. Little is known about CCC patients older than 70 years who have undergone hepatectomy.

Methods

Between 1977 and 2004, the clinical features of 33 elderly CCC patients (>70 years old) undergoing hepatectomy were reviewed, and 185 CCC patients younger than 70 years (younger CCC) were used for comparison.

Results

A total of 218 CCC patients undergoing hepatectomy were investigated with ages ranging from 28 to 93 years (median, 59.0 years). The elderly and younger CCC groups had a similar sex ratio and a similar positive rate of carcinoembryonic antigen (CEA) and CA19-9. A similar rate of hepatolithiasis, mucobilia, papillary pattern, stage distribution, curative hepatectomy, surgical morbidity, and mortality for CCC were also observed between the two groups. During a follow-up duration ranging from 1.1 to 145.0 months (median, 11.7 months), elderly CCC and younger CCC patients had similar prognoses after hepatectomy (P = .827). Elderly CCC patients with a low CEA level, an intraductal papillary growth pattern, curative hepatectomy, and postoperative chemotherapy tended to have favorable survival. However, elderly CCC patients with a low CEA level independently showed favorable survival.

Conclusions

Hepatectomy is feasible for selected elderly CCC patients. Elderly CCC patients undergoing hepatectomy had clinicopathologic features and prognoses similar to those of patients younger than 70 years undergoing hepatectomy. Elderly CCC patients with a low CEA level, intraductal papillary growth pattern, curative hepatectomy, and postoperative chemotherapy tended to have favorable survival. However, elderly CCC patients with low CEA level independently showed favorable survival.
Literature
1.
go back to reference Chen MF. Peripheral cholangiocarcinoma (cholangiocellular carcinoma): clinical features, diagnosis and treatment. J Gastroenterol Hepatol 1999; 14:1144–9PubMedCrossRef Chen MF. Peripheral cholangiocarcinoma (cholangiocellular carcinoma): clinical features, diagnosis and treatment. J Gastroenterol Hepatol 1999; 14:1144–9PubMedCrossRef
2.
go back to reference Liver Cancer Study Group of Japan. Classification of Primary Liver Cancer. Tokyo: Kanehara, 1997 Liver Cancer Study Group of Japan. Classification of Primary Liver Cancer. Tokyo: Kanehara, 1997
3.
go back to reference Suzuki H, Isaji S, Pairojkul C, Uttaravichien T. Comparative clinicopathological study of resected intrahepatic cholangiocarcinoma in northeast Thailand and Japan. J Hepatobiliary Pancreat Surg 2000; 7:206–11PubMedCrossRef Suzuki H, Isaji S, Pairojkul C, Uttaravichien T. Comparative clinicopathological study of resected intrahepatic cholangiocarcinoma in northeast Thailand and Japan. J Hepatobiliary Pancreat Surg 2000; 7:206–11PubMedCrossRef
4.
go back to reference Sirica AE, Gainey TW, Harrell MB, Caran N. Cholangiocarcinogenesis and biliary adaptation responses in hepatic injury. In: Sirica AE, Longnecker DS, eds. Biliary and Pancreatic Ductal Epithelia—Pathobiology and Pathophysiology. New York: Marcel Dekker, 1997; 229–90 Sirica AE, Gainey TW, Harrell MB, Caran N. Cholangiocarcinogenesis and biliary adaptation responses in hepatic injury. In: Sirica AE, Longnecker DS, eds. Biliary and Pancreatic Ductal Epithelia—Pathobiology and Pathophysiology. New York: Marcel Dekker, 1997; 229–90
5.
go back to reference Wang J, Grossman B. Bladder carcinoma in patients age 40 years or younger. Cancer 1989; 64:178–81CrossRef Wang J, Grossman B. Bladder carcinoma in patients age 40 years or younger. Cancer 1989; 64:178–81CrossRef
6.
go back to reference Bloss RSD, Miller TA, Copeland EM. Carcinoma of the stomach in the young adult. Surg Gynecol Obstet 1980; 150:883–6PubMed Bloss RSD, Miller TA, Copeland EM. Carcinoma of the stomach in the young adult. Surg Gynecol Obstet 1980; 150:883–6PubMed
7.
go back to reference Recalde M, Holyoke ED, Elias EG. Carcinoma of the colon, rectum, and anal canal in young patients. Surg Gynecol Obstet 1974; 139:909–13PubMed Recalde M, Holyoke ED, Elias EG. Carcinoma of the colon, rectum, and anal canal in young patients. Surg Gynecol Obstet 1974; 139:909–13PubMed
8.
go back to reference Monte SM, Mutchins GM, Moore GW. Influence of age on the metastatic behavior of breast carcinoma. Hum Pathol 1988; 19:529–34PubMedCrossRef Monte SM, Mutchins GM, Moore GW. Influence of age on the metastatic behavior of breast carcinoma. Hum Pathol 1988; 19:529–34PubMedCrossRef
9.
go back to reference Yeh CN, Jan YY, Chen MF. Influence of age on surgical treatment of peripheral cholangiocarcinoma. Am J Surg 2004; 187:559–63PubMedCrossRef Yeh CN, Jan YY, Chen MF. Influence of age on surgical treatment of peripheral cholangiocarcinoma. Am J Surg 2004; 187:559–63PubMedCrossRef
10.
go back to reference Poon RTP, Fan ST, Lo CM, et al. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management. Am J Gastroenterol 1999; 94:2460–6PubMedCrossRef Poon RTP, Fan ST, Lo CM, et al. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management. Am J Gastroenterol 1999; 94:2460–6PubMedCrossRef
11.
go back to reference Yeh CN, Lee WC, Jeng LB, Chen MF. Hepatic resection for hepatocellular carcinoma in elderly patients. Hepatogastroenterology 2004; 51:219–23PubMed Yeh CN, Lee WC, Jeng LB, Chen MF. Hepatic resection for hepatocellular carcinoma in elderly patients. Hepatogastroenterology 2004; 51:219–23PubMed
12.
go back to reference Healy JE, Schroy PC. Anatomy of the biliary ducts within the human liver: analysis of the prevailing pattern of branching and the major variations of the biliary ducts. Arch Surg 1953; 66:599–616 Healy JE, Schroy PC. Anatomy of the biliary ducts within the human liver: analysis of the prevailing pattern of branching and the major variations of the biliary ducts. Arch Surg 1953; 66:599–616
13.
go back to reference Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. Paris: Masson Publishers, 1957:187–208 Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. Paris: Masson Publishers, 1957:187–208
14.
go back to reference Ponsioen CIJ, Tytgat GNJ. Primary sclerosing cholangitis: a clinical review. Am J Gastroenterol 1998; 93:515–23PubMedCrossRef Ponsioen CIJ, Tytgat GNJ. Primary sclerosing cholangitis: a clinical review. Am J Gastroenterol 1998; 93:515–23PubMedCrossRef
15.
go back to reference Harrison PM. Prevention of bile duct cancer in primary sclerosing cholangitis. Ann Oncol 1999; 10(Suppl 4):S208–11CrossRef Harrison PM. Prevention of bile duct cancer in primary sclerosing cholangitis. Ann Oncol 1999; 10(Suppl 4):S208–11CrossRef
16.
go back to reference Komi N, Tamura T, Miyoshi Y. Histochemical and immunohistochemical studies on development of biliary carcinoma in forty-seven patients with choledochal cysts—special reference to intestinal metaplasia in the biliary duct. Jpn J Surg 1985; 15:273–8PubMedCrossRef Komi N, Tamura T, Miyoshi Y. Histochemical and immunohistochemical studies on development of biliary carcinoma in forty-seven patients with choledochal cysts—special reference to intestinal metaplasia in the biliary duct. Jpn J Surg 1985; 15:273–8PubMedCrossRef
17.
go back to reference Imazu M, Iwai N, Tokiwa K, et al. Factors of biliary carcinogenesis in choledochal cysts. Eur J Pediatr Surg 2001; 11:24–7PubMedCrossRef Imazu M, Iwai N, Tokiwa K, et al. Factors of biliary carcinogenesis in choledochal cysts. Eur J Pediatr Surg 2001; 11:24–7PubMedCrossRef
18.
go back to reference Weber SM, Jarnagin WR, Klimstra D. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg 2001; 193:384–91PubMedCrossRef Weber SM, Jarnagin WR, Klimstra D. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg 2001; 193:384–91PubMedCrossRef
19.
go back to reference Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 2001; 33:1353–7PubMedCrossRef Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 2001; 33:1353–7PubMedCrossRef
20.
go back to reference Shirabe K, Shimada M, Harimoto N. Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery 2002; 131:S159–64PubMedCrossRef Shirabe K, Shimada M, Harimoto N. Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery 2002; 131:S159–64PubMedCrossRef
21.
go back to reference Chen TC, Nakanuma Y, Zen Y, et al. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology 2001; 34:651–8PubMedCrossRef Chen TC, Nakanuma Y, Zen Y, et al. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology 2001; 34:651–8PubMedCrossRef
22.
go back to reference Cattel RB, Brausch JW, Kahn F. Polypoid epithelial tumors of the bile duct. N Engl J Med 1962; 226:57–61CrossRef Cattel RB, Brausch JW, Kahn F. Polypoid epithelial tumors of the bile duct. N Engl J Med 1962; 226:57–61CrossRef
23.
go back to reference Suh KS, Roh HR, Koh YT, et al. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology 2000; 31:12–7PubMedCrossRef Suh KS, Roh HR, Koh YT, et al. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology 2000; 31:12–7PubMedCrossRef
24.
go back to reference Buskirk S, Gunderson L, Adson M, et al. Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 1984; 10:2013–23PubMed Buskirk S, Gunderson L, Adson M, et al. Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 1984; 10:2013–23PubMed
25.
go back to reference Yeh CN, Jan YY, Yeh TS, et al. Hepatic resection of intraductal papillary type of cholangiocarcinoma. Ann Surg Oncol 2004; 11:606–11PubMedCrossRef Yeh CN, Jan YY, Yeh TS, et al. Hepatic resection of intraductal papillary type of cholangiocarcinoma. Ann Surg Oncol 2004; 11:606–11PubMedCrossRef
26.
go back to reference Kokudo N, Makuuchi M. Extent of resection and outcome after curative resection for intrahepatic cholangiocarcinoma. Surg Oncol Clin North Am 2002; 11:969–83CrossRef Kokudo N, Makuuchi M. Extent of resection and outcome after curative resection for intrahepatic cholangiocarcinoma. Surg Oncol Clin North Am 2002; 11:969–83CrossRef
27.
go back to reference Jan YY, Yeh CN, Yeh TS, Hwang TL, Chen MF. Clinicopathological factors predicting long-term overall survival after hepatectomy for peripheral cholangiocarcinoma. World J Surg 2005; 29:894–8PubMedCrossRef Jan YY, Yeh CN, Yeh TS, Hwang TL, Chen MF. Clinicopathological factors predicting long-term overall survival after hepatectomy for peripheral cholangiocarcinoma. World J Surg 2005; 29:894–8PubMedCrossRef
28.
go back to reference Cantore M, Rabbi C, Guadagni S, et al. Intra-arterial hepatic chemotherapy combined with continuous infusion of 5-fluorouracil in patients with metastatic cholangiocarcinoma. Ann Oncol 2002; 13:1687–8PubMedCrossRef Cantore M, Rabbi C, Guadagni S, et al. Intra-arterial hepatic chemotherapy combined with continuous infusion of 5-fluorouracil in patients with metastatic cholangiocarcinoma. Ann Oncol 2002; 13:1687–8PubMedCrossRef
29.
go back to reference Heyna M, Pruckmayer M, Radere M. The role of chemotherapy and radiation in the management of biliary cancer: a review of the literature. Eur J Cancer 1998; 34:977–86CrossRef Heyna M, Pruckmayer M, Radere M. The role of chemotherapy and radiation in the management of biliary cancer: a review of the literature. Eur J Cancer 1998; 34:977–86CrossRef
30.
go back to reference Ellis PA, Norman A, Hill A, et al. Epirubicin, cisplatin and infusional 5-fluorouracil (ECF) in hepatobiliary tumours. Eur J Cancer 1995; 31:1594–8CrossRef Ellis PA, Norman A, Hill A, et al. Epirubicin, cisplatin and infusional 5-fluorouracil (ECF) in hepatobiliary tumours. Eur J Cancer 1995; 31:1594–8CrossRef
Metadata
Title
Hepatectomy for Peripheral Cholangiocarcinoma in Elderly Patients
Authors
Chun-Nan Yeh, MD
Yi-Yin Jan, MD, FACS
Miin-Fu Chen, MD, FACS
Publication date
01-12-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9085-x

Other articles of this Issue 12/2006

Annals of Surgical Oncology 12/2006 Go to the issue