R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer

Liver Int. 2011 Jan;31(1):99-107. doi: 10.1111/j.1478-3231.2010.02345.x. Epub 2010 Sep 16.


Background: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).

Aim: To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.

Method: We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n = 237, gallbladder cancer n = 84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.

Results: Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.

Conclusion: In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / drug therapy*
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery*
  • Bile Ducts, Intrahepatic* / pathology
  • Biliary Tract Surgical Procedures*
  • Chemotherapy, Adjuvant
  • Chi-Square Distribution
  • Cholangiocarcinoma / drug therapy*
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / surgery*
  • Drainage
  • Female
  • Gallbladder Neoplasms / drug therapy*
  • Gallbladder Neoplasms / mortality
  • Gallbladder Neoplasms / pathology
  • Gallbladder Neoplasms / surgery*
  • Humans
  • Kaplan-Meier Estimate
  • London
  • Male
  • Middle Aged
  • Palliative Care
  • Photochemotherapy*
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome