Extrahepatic Cholangiocarcinoma: Experience from Misurata Cancer Center, Libya (2012-2014)

Twenty five patientswere registered in Misurata Cancer Center between January, 2012and June, 2014 to haveextrahepaticcholangiocarcinoma (ECC). The median age was 52years (range from 32-78 years). Eighteen patients(72%) were males and7 patients (28%)were females.Fourteen patients had ECOG performance status score 0 or 1 and 11 patientshad score 2 or 3. All the patients presented with obstructive jaundice. Fifteen patients(60%) had perihilar (Klatskin) tumors, and the remaining (40%) had distal bile duct tumors.Twelve patients had cytological or histological confirmatory diagnosis. Six patientsunderwent preoperative laparoscopic evaluation before surgery, 2 of them proved to havedisseminated peritoneal deposits and rendered inoperable.Atotal 21 patient were rendered tohave unresectable tumor due to either extensive liver infiltration (6 patients), ornon regionalLN metastasis and/or distant metastasis (15patients).Four patients underwent Whipplesurgery, one patient died due to sepsis and hemorrhage,and 3 patients remained alive tilltime of analysis, one of them received 6 cycles of adjuvant chemotherapy (gemcitabine andcisplatin) due to lymph node metastasis. Of the remaining 21 patients, 18 patientsunderwent biliary stenting guided by ERCP (16 patients) or PTC (2 patients). The bilirubinwas normalized in 15 patients. A total of 13 patients received palliativechemotherapy,gemcitabine/cisplatin regimen. The total number of chemotherapy cycles was 67 cycles(range from 2-9 cycles per patient). Eight of 13 patients (61.5%) who receivedchemotherapy had any ≥ grade 3 (severe) toxicity. The most common severe chemotherapytoxicities were neutropenia (6 patients 46%), anemia (4 patients 31%), thrombocytopenia (3patients 23%), neutropenic fever (2 patients 15%), nausea and vomiting (3 patients 23%),and lethargy( 2 patients 15%).Complete response (CR) was achieved in 1 patient (7.6%),partial response (PR) in 3 patients (23%) and stable disease (SD) in 5 patients (38.4%)while 4 patients (31%) had disease progression (DP) during therapy.The medianprogression free survival (PFS) was 4.4 months. The median overall survival (OS) was 8.4months.