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

Seo, Seok In; Hwang, Shin; Lee, Young Joo; Kim, Ki Hun; Ahn, Chul Soo; Moon, Deok Bog; Ha, Tae Yong; Song, Gi Won; Jung, Dong Hwan; Park, Kwang Min; Hwang, Dae Wook; Lee, Sung Gyu

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.