Unresectable Cholangiocarcinoma in Thailand: Comparison of Outcomes with Stent Types

Cholangiocarcinoma (CCA) is a fatal malignancy that accounts for 10-25% of primary hepatobiliary cancers (Anderson et al., 2012). Although the incidence was only 0.58-0.88 per 100,000 people in the USA, some particular endemic areas in Southeast Asia, especially northeastern Thailand, reported incidences as high as 39.4 and 94.8 per 100,000 people for females and males, respectively (Ruys et al., 2012; Sangchan et al., 2012). However, the incidence in Western countries had gradually risen in recent decades (Aslanian and Jamidar, 2011). The reasons for this increment are unclear. The etiology of CCA in Asian countries appears related to infestation by liver fluke, particularly the Opistorchiidae family (Shin et al., 2010), whereas CCA in Western countries is caused by chronic bile duct inflammation, particularly primary sclerosing cholangitis. A metaanalysis revealed that chronic hepatitis B and hepatitis C infection also increase the risk of this malignancy (Zhou et al., 2012). CCA is generally divided to intrahepatic and extrahepatic types. Extrahepatic CCA was also classified as distal or hilar CCA according to the Bismuth-Corlette classification (Klatskin, 1965). In Western countries, approximately 60-70% of cases of CCA were reported to be hilar CCA, whereas distal and intrahepatic CCA comprised 20-30 and 5-10% of