The Effect of Combined Hepatic Resection for Proximal Bile Duct Cancer: comparison with nonsurgical metallic stent insertion

Choi, D W; Lee, B H; Lee, M J; Moon, S M; Paik, N S; Moon, N M

Abstract

BACKGROUND/AIMS: Best treatment option for proximal bile duct cancer is not determined till now since Klatskin's report in 1965.The range of therapeutic modality varies from a curative resection including hepatectomy to minimal therapy with percutaneously placed stent insertion. This study was conducted to evaluate the resectability and postoperative morbidity and mortality following hepatic resection for proximal bile duct cancer and to assess the survival benefit and quality of life compared with nonsurgical metallic stent insertion.
MATERIALS AND METHODS
34 patients underwent nonsurgical metallic biliary stent insertion for proximal bile duct cancer from Sep-1991 through Sep-1994. On the other hand, 15 patients were operated on for same lesions from Mar-1994 through Feb-1997 in KCCH. Age and sex ratio were comparable between two groups. Among 13 patients who underwent combined hepatic resection, 3 RL, 2 ERL, 5 ERL plus CL and 3 HPD were performed after biliary drainage.
RESULTS
Resectability was 86.7% (13/15) and pathologically curative resection rate was 84.6% (11/13). 13 postoperative complications developed in 8 patients (61.6%), most of which were pulmonary origin. Single patient succumbed to pneumonia and ARDS. The 1-, 2-, 3 year survival rates for 15 surgery group were statistically superior to those of stent group (p=0.0001). And readmission and reintervention were needed more frequently in stent group due to stent occlusion and cholangitis.
CONCLUSION
Surgical resection including combined hepatectomy should be performed for the proximal bile duct cancer for survival prolongation and better quality of life. And postoperative mortality may be overcome through diligent pulmonary care with preoperative biliary drainage.