Aims: Because of the late presentation of symptoms, hilar cholangiocellular carcinomas
are usually diagnosed in later stages and in general therapy concept can not be curative.
Palliative treatment strategies include endoscopic retrograde cholangio-pancreatography,
percutaneous transhepatic biliary drainage or surgery. Patients and methods: 96 consecutive patients underwent treatment for malignant hilar bile duct tumors during
a period of 11 years. To assess prognostic factors and clinical outcome the patients
were reviewed retrospectively. Results: 76/96 patients were treated only by endoscopic procedures using ERC (n=45) and/or
PTBD (n=31). 20/96 patients were initially treated by surgery (n=2 R0 / n=18 R1).
All 18 R1-resected patients had recurrent obstruction and later on required ERC or
PTBD. Median survival time in all 96 patients was 650 days, and correlated significantly
with bismuth stage and bilirubin levels at the time of primary diagnosis. Average
survival time of R1-resected patients in Bismuth stage III/IV was 1403/511 days compared
to 442/274 days in non resected patients. Conclusions: Median survival of the patients depends on the tumor stage and bilirubin levels.
Patients treated by ERC and PTCD seem to have a shorter overall survival than operated
patients. Future studies will determine whether a more aggressive surgical approach
in advanced cases or, alternatively, endoscopic treatment with photodynamic therapy
can actually reveal a benefit or might even be performed subsequently.
