Introduction : Hilar cholangiocarcinoma is known a tumor that have a poor prognosis despite surgical resection. Many patients are diagnosed at advanced stages of disease, especially Bismuth type IV that have worst prognosis traditionally. We retrospectively analyzed survival outcomes of hilarcholangiocarcinoma after surgical resection.

Methods : We retrospectively reviewed the 107 patients who were received surgical resection for hilar cholangiocarcinoma at our hospital between 1998 and 2017. The clinical factors associated with survival were analyzed using univariate and multivariate tests.

Results : Among 107 cases, 5-year overall survival was 34.4% and 5-year disease free survival was 28.0% after surgical resection. There were no significant difference of survival according to Bismuth and gross type. The multivariate analysis showed that CA19-9 elevation, present of PV invasion and advanced AJCC stages were independently poor prognostic factors for the disease free and overall survival. In Bismuth type I and II, types of surgery were 6 (46.2%) major hepatectomy and 7 (53.8%) bile duct resection(BDR). Among the 7 patients who underwent BDR, R1 resection was 5 (71.4%). Although R1 resection was done frequently in Bismuth type IV, 5-year overall survival was not significantly different between R0 (n=4, 66.7%) and R1 (n=15, 33.3%, P=0.740) resection.

Conclusions : In our cases, rate of R1 in BDR of Bismuth type I and II is high, surgeon should consider major hepatectomy if safety resection margin is uncertain. Although R1 resection is more frequent in Bismuth type IV, there was survival benefit in R1 resection. Therefore, surgical resection should be considered even in extensive cases including type IV.