Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):109-112. 10.14701/kjhbps.2013.17.3.109.

Technical knacks and outcomes of extended extrahepatic bile duct resection in patients with mid bile duct cancer

Affiliations
  • 1Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr

Abstract

BACKGROUNDS/AIMS
Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extrahepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgical procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection.
METHODS
We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a > or =2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years.
RESULTS
The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively.
CONCLUSIONS
We suggest that extended EHBD resection can be performed as a beneficial option to achieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome.

Keyword

Bile duct cancer; Extended bile duct resection; Pancreaticoduodenectomy; Resection margin

MeSH Terms

Aged
Bile
Bile Duct Neoplasms
Bile Ducts
Bile Ducts, Extrahepatic
Hepatic Duct, Common
Humans
Pancreatic Juice
Pancreaticoduodenectomy
Survival Rate
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