Segmental Resection for Extrahepatic Bile Duct Cancer (excluding GB cancer)

Kim, Jeong Han; Kim, Yong Il

Abstract

PURPOSE: It is difficult to preoperatively determine the extent of surgery for extrahepatic cholangiocarcinoma due to its proximity to vital structures. Recently the tendency of combined resection of liver and pancreas for the treatment of this appears to be increasing, although, in spite of the expected survival benefit, this radical surgery cannot be applied to all extrahepatic cholangiocarconoma because of the high rate of operative complications. We reviewed patients who had undergone segmental resection of the bile duct vice radical surgery for extrahepatic cholangiocarconoma in order to study their clinical features and to analyze the prognostic factors for survival.
METHODS
Thirty-four patients who underwent segmental resection for extrahepatic cholangiocarcinoma, excepting GB cancer, at our center between 1994 to 2000 were included in this study and their medical records were reviewed retrospectively.
RESULTS
The mean age of the patients was 63 years and they underwent segmental resection of bile duct and skeletalization of the hepatoduodenal ligament with hepatico-jejunostomy. The mean length of hospital stay after operation was 17.2 days (8~44) and no operative mortality was encountered. Postoperative complications including 5 wound dehiscences, 1 intraperitoneal abscess, 1 pyloric obstruction and 1 case of gastric ulcer bleeding were all improved following conservative management. The mean size of tumors was 2.6 cm and 11 tumors (32%) involved the resection margin. The estimated 2 and 4 year survival rates of the 34 patients following resection was 64% and 22% respectively and the only significant predictive factor for survival following resection was the tumor involvement of resection margin (P=0.045). The 2-year survival rate of the positive margin group was 34%, although that of the free margin group was 74%.
CONCLUSION
Segmental resection for extrahepatic cholangiocarconoma may be a reasonable option offering relatively low morbidity and mortality if the resection margin is tumor- free. Additionally, segmental resection may be more beneficial to patients with high operative risk in particular.