Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Comparison of Survival Outcomes following Segmental Bile Duct Resection versus Pancreatoduodenectomy for Mid Bile Duct Cancer

중간부 담도암 환자에서 담도분절절제와 췌두십이지장절제에 따른 예후 비교

  • Seo, Seok-In (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwang, Shin (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Young-Joo (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ki-Hun (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Chul-Soo (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Deok-Bog (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ha, Tae-Yong (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Gi-Won (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Dong-Hwan (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Kwang-Min (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwang, Dae-Wook (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sung-Gyu (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 서석인 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 황신 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 이영주 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 김기훈 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 안철수 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 문덕복 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 하태용 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 송기원 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 정동환 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 박광민 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 황대욱 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 이승규 (울산대학교 의과대학 서울아산병원 외과학교실)
  • Published : 2011.02.28
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Abstract

Purpose: This study was designed to analyze the prognosis following segmental bile duct resection (BDR) versus pancreatoduodenectomy (PD) for mid bile duct (mBD) cancer. Methods: During the 4 years between 2003 and 2006, 55 patients underwent surgical resection for mBD cancer in our institution. Medical records were reviewed retrospectively. They were divided into two groups, a BDR group (n=24) and a PD group (n=31) according to the extent of resection. Results: Median follow-up was 43 months. Overall 3- and 5-year survival rates were 56.0% and 33.8%, respectively. The BDR group had lower tumor stages than the PD group (p=0.011). R0 resection was achieved in 17 (70.8%) of the BDR group and 30 (96.8%) of the PD group. Median survival periods were 43 and 34 months after R0 and R1 resections, respectively (p=0.715). Recurrence occurred in 41 patients after a mean period of 18 months. Three- and 5-year survival rates were 62.5% and 27.2% after BDR, respectively, and 51.5% and 34% after PD, respectively (p=0.715). No significant risk factors for shorter patient survival times was identified. Aggressive treatment of recurrence did not appear to prolong patient survival. Conclusion: The extent of resection for mBD cancer did not affect the survival outcome when R0 resection was achieved. Considering the operative risk in patients with older ages or co-morbidities, PD should be considered only after obtainment of simultaneous tumor-free radial and proximal longitudinal resection margins.

Keywords

References

  1. Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg 2005;241:77-84.
  2. Chamberlain RS, Blumgart LH. Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol 2000;7:55-66. https://doi.org/10.1007/s10434-000-0055-4
  3. Nagorney DM, Donohue JH, Farnell MB, Schleck CD, Ilstrup DM. Outcomes after curative resections of cholangiocarcinoma. Arch Surg 1993;128:871-877. https://doi.org/10.1001/archsurg.1993.01420200045008
  4. Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 1997;15:947-954. https://doi.org/10.1200/JCO.1997.15.3.947
  5. Pichlmayr R, Weimann A, Klempnauer J, et al. Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg 1996;224:628-638. https://doi.org/10.1097/00000658-199611000-00007
  6. Allen PJ, Reiner AS, Gonen M, et al. Extrahepatic cholangiocarcinoma: a comparison of patients with resected proximal and distal lesions. HPB (Oxford) 2008;10:341-346. https://doi.org/10.1080/13651820802276630
  7. Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996;224:463-473. https://doi.org/10.1097/00000658-199610000-00005
  8. Tompkins RK, Thomas D, Wile A, Longmire WP Jr. Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg 1981;194:447-457. https://doi.org/10.1097/00000658-198110000-00008
  9. Heron DE, Stein DE, Eschelman DJ, et al. Cholangiocarcinoma: the impact of tumor location and treatment strategy on outcome. Am J Clin Oncol 2003;26:422-428.
  10. Todoroki T, Kawamoto T, Koike N, Fukao K, Shoda J, Takahashi H. Treatment strategy for patients with middle and lower third bile duct cancer. Br J Surg 2001;88:364-370. https://doi.org/10.1046/j.1365-2168.2001.01685.x
  11. Gwak HK, Kim WC, Kim HJ, Park JH. Extrahepatic bile duct cancers: surgery alone versus surgery plus postoperative radiation therapy. Int J Radiat Oncol Biol Phys 2010;78: 194-198. https://doi.org/10.1016/j.ijrobp.2009.07.003
  12. Reding R, Buard JL, Lebeau G, Launois B. Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumors excluded). Results of the French Surgical Association Survey. Ann Surg 1991;213: 236-241. https://doi.org/10.1097/00000658-199103000-00010
  13. Hwang S, Lee SG, Kim KH, et al. Extended extrahepatic bile duct resection to avoid performing pancreatoduodenectomy in patients with mid bile duct cancer. Dig Surg 2008;25:74-79. https://doi.org/10.1159/000118025
  14. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.
  15. Jarnagin WR, Ruo L, Little SA, et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 2003;98:1689-1700. https://doi.org/10.1002/cncr.11699
  16. Borghero Y, Crane CH, Szklaruk J, et al. Extrahepatic bile duct adenocarcinoma: patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone. Ann Surg Oncol 2008;15: 3147-3156. https://doi.org/10.1245/s10434-008-9998-7