The effect of curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer

Kim, Jeong Il; Kang, Sun Hyoung; Nam, Gwan Woo; Kwon, Dae Soon; Goh, Pyung Gohn; Hwang, Se Woong; Ko, Kwang Hun; Jung, Jae Hoon; Moon, Hee Seok; Sung, Jae Kyu; Kim, Seok Hyun; Lee, Byung Seok; Lee, Heon Young

Abstract

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer.
METHODS
The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU.
RESULTS
Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy.
CONCLUSIONS
Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.