Criteria for liver resection for metastasis from bile duct cancer
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ORIGINAL ARTICLE
Criteria for liver resection for metastasis from bile duct cancer Shintaro Yamazaki1 · Tadatoshi Takayama1 · Yusuke Mitsuka1 · Nao Yoshida1 · Tokio Higaki1 Received: 16 July 2020 / Accepted: 20 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Background The surgical indications for liver metastasis from bile duct cancer remain contentious, because surgery is generally thought unlikely to improve survival. However, recent reports show that long-term survival has been achieved with liver resection of metastasis from recurrent bile duct cancer in selected patients. Methods Liver resection for liver metastasis from bile duct cancer was proposed only when the following criteria were met: liver-only metastasis, a solitary tumor, and no increase in the number of lesions during 3 months of observation. This study aimed to validate our criteria and to analyze which factors impact on survival. Result Between 2003 and 2017, 164 patients underwent pathologically curative resection for bile duct cancer. Recurrence developed in 98 of these patients, as liver-only metastasis in 25. Eleven of these 25 patients underwent liver resection (liver resection group), and 14 did not (non-liver resection group). The median overall survival was longer in the liver resection group than in all the patients (44 months vs. 17.8 months, respectively p = 0.040). The median overall survival was better in the liver resection group than in the non-liver resection group (44 months vs. 19.9 months, p = 0.012). The disease-free interval was also significantly longer in the liver resection group than in the non-liver resection group [22 months (range; 4–34 months) vs. 3 months (2–11), p 12 months from first liver resection. Otherwise, the indications for second liver resection were the same as for the first liver resection.
Liver resection Liver resection was performed using a clamp and crush method and perioperative care was given according to our institutional protocols, as described previously [18]. Nonanatomical partial resection was the first-line procedure for liver metastasis. When occlusion of hepatic inflow was impossible, as a result of biliary reconstruction in a previous operation, liver resection was performed without Pringle’s maneuver. The median follow-up from the primary operation was 22 months (range, 2–101 months).
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Statistical analysis Data are expressed as medians and ranges or as absolute values and percentages. Student’s t test, Chi square test, and Fisher’s exact test were used for univariate analysis, as appropriate. Survival curves were obtained using the Kaplan–Meier method, and comparisons were performed using the log-rank test. Values of p
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