Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma Kosuke Jikei, MD1, Tomoki Ebata, MD1, Takashi Mizuno, MD1, Takanori Kyokane, MD2, Hideo Matsubara, MD3, Shinya Yokoyama, MD4, Kenji Kato, MD5, Kiyoshi Suzumura, MD6, Mizuo Hashimoto, MD7, Satoru Kawai, MD8, Masato Nagino, MD1, and the Nagoya Surgical Oncology Group 1
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan; 3Department of Surgery, Yachiyo Hospital, Anjo, Japan; 4Department of Surgery, Meijo Hospital, Nagoya, Japan; 5Department of Surgery, Inazawa Municipal Hospital, Inazawa, Japan; 6Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan; 7Department of Surgery, Chubu-Rosai Hospital, Nagoya, Japan; 8Department of Surgery, Tsushima City Hospital, Tsushima, Japan
2
ABSTRACT Background. Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology. Methods. Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR. Results. During the study, 92 patients underwent BDR (n = 38) or PD (n = 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (P = 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (P = 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76; P = 0.023]
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09157-3) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 12 May 2020 Accepted: 29 August 2020 T. Ebata, MD e-mail: [email protected]
by multivariable analysis. In the BDR group, tumor length \ 15 mm (HR, 3.38; P = 0.017) and ductal margin length C 10 mm (HR, 2.54; P = 0.018) were independent positive prognostic factors. Stratified by these two favorable factors, the 5-year survival rate was 63.0% in patients with 1/2 factors and 6.7% in those with 0 factors (P \ 0.001). Conclusion. In patients with MCC, BDR provided a better short-term and a worse long-term outcome than PD. However, patient selection using tumor length and ductal margin length may allow a favorable survival probability even after BDR.
Cholangiocarcinoma is broadly classified into intrahepatic, perihilar, and distal categories according t
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