By Jeyashree Sundaram (MBA)
Cholangiocarcinoma (bile duct cancer) usually develops in the bile duct system that arises from the liver and bile ducts and ends at the small intestine.
Cancer that develops in the section of bile ducts within and outside the liver is called as intrahepatic and hilar cholangiocarcinoma, respectively. Distal cholangiocarcinoma is developed in the bile section that is associated with small intestine. Prognostic factors of cholangiocarcinoma are highly disputable.
The prognosis of bile duct cancer is affected by various factors such as the site of cancer, type and grade (extent of cell abnormalities when examined under a microscope) of cholangiocarcinoma, physical health condition, treatment, etc.
The risk factors for bile duct cancer include primary sclerosing cholangitis (a gradually developing disorder in which inflammation and scarring block bile ducts), chronic ulcerative colitis, and cysts within the bile ducts (these block bile flow, leading to bile duct enlargement, infection, and inflammation).
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Post-Segmentectomy Prognostic Factors of Distal Cholangiocarcinoma
Distal bile duct cancer is the most common type of bile duct cancer after intrahepatic bile duct cancer. Nevertheless, the prognosis of distal cholangiocarcinoma is better when compared to other two types of bile duct cancer.
Initial stage symptoms of distal cholangiocarcinoma include cholangitis, jaundice, etc. These symptoms can help in early identification of the disease.
Further development of the tumor can be prevented by segmentectomy. Some of the risk factors that affect the prognosis of distal bile duct cancer are perineural infiltration, tumor markers, tumor cell differentiation, serum bilirubin, lymph node metastasis, amount of transfusion, age, etc.
Complications within a Month Post-Surgery
Around 44% of patients suffered from complications after a month of surgery. Complications experienced by bile duct cancer patients after they are treated with pancreaticoduodenectomy and whipple procedures for distal bile duct cancer are as follows.
The most common postoperative problem faced is collection of intra-abdominal fluid and postoperative bleeding, which was experienced by almost 37% patients post-operation.
Few patients suffered with life-threatening consequences such as liver failure, left hepatic artery damage, etc. Minimum number of patients hadn’t survived.
Complications in Average Follow-up Period (2 to 177 Months)
Around 47% of patients were affected by distal bile duct cancer for the second time, which indicates that 53% of patients do not experience recurrence during follow-up.
Out of the patients experienced with recurrence bile duct cancer, 47.3% of the patients were affected by local recurrence, 30% were affected with intrahepatic recurrence, and 23.2% were affected with systematic recurrence.
The survival rate within first three years after the operation is around 55.3%. After five years, the survival rate was around 48.3%. Finally, after ten years, it was around 33.7%.
Post-Segmentectomy Prognostic Factors of Extrahepatic Cholangiocarcinoma
After extrahepatic cholangiocarcinoma segmentectomy, various data are subjected to evaluation to find the prognostic factors after segmentectomy of extrahepatic bile duct cancer. Such data include postoperative adjuvant treatment, pathologic factors, patient demographics, and intraoperative factors.
Lymph node metastasis, tumor histology, and 5th American Joint Committee on Cancer stage were significant prognostic factors. Lymph node metastasis and tumor histology were identified as the prognostic factors that are independent, during the Cox proportional hazard regression for multivariate analysis.
Despite the fact that the patients suffering from lymph node metastasis had experienced mean recurrence than those are not affected by lymph node metastasis, some patients attained cure post-segmentectomy.
Around 20% to 30 % of the extrahepatic bile duct cancer patients survive for five years after surgical resection. Some patients survive even after five years even though they are affected with recurrent extrahepatic bile duct cancer.
In some cases, recurrent bile duct cancer is identified only after five years post-segmentectomy. But the average survival rate is less when compared to the first five-year survival rate.
The average survival rate within first year after the segmentectomy was around 72.9%. After three years, the survival rate was around 41.1%. Finally, after five years, it was around 32.5%.
Factors Influencing Prognostic Factors in Advanced Cholangiocarcinoma After Surgery and Chemotherapy
The survival rate of patients affected with advanced cholangiocarcinoma in the first year after the therapy, such as segmentectomy, chemotherapy, etc., was around 10.8%. After three years, the survival rate was around 5.4%.
Finally, after five years, it was around 4.5%. Average survival rate of advanced bile duct cancer was eight and a half months. Univariate analysis method was used to evaluate the impact of various factors such as tumor-related, treatment, and multiple clinical parameters on advanced cholangiocarcinoma survival.
Some of the parameters that do not affect the prognosis of advanced cholangiocarcinoma are perineural invasion, stenting, vascular invasion, age, history of cholelithiasis, resection margin status, diabetes, presence of metastasis, and gender.
The prognosis of advanced bile duct cancer is also not influenced by size, location, and stage of the tumor. Survival rate of patients who underwent surgery was less compared to those treated with chemotherapy.