Ann Surg Treat Res.  2018 May;94(5):240-246. 10.4174/astr.2018.94.5.240.

Bile duct segmental resection versus pancreatoduodenectomy for middle and distal common bile duct cancer

• Kim N
• Lee H
• Min SK
• Lee HK

• KMID: 2410267
• DOI: http://doi.org/10.4174/astr.2018.94.5.240

Abstract

PURPOSE
To compare survival outcomes between bile duct segmental resection (BDR) and pancreatoduodenectomy (PD) for the treatment of middle and distal bile duct cancer.
METHODS
From 1997 to 2013, a total of 96 patients who underwent curative intent surgery for middle and distal bile duct cancer were identified. The patients were divided into 2 groups based on the type of operation; 20 patients were included in the BDR group and 76 patients were in the PD group. We retrospectively reviewed the clinical outcomes.
RESULTS
The number of lymph nodes (LNs) was significantly greater in patients within the PD group compared to the BDR group. The total number of LNs was 6.5 ± 8.2 vs. 11.2 ± 8.2 (P = 0.017) and the number of metastatic LNs was 0.4 ± 0.9 vs. 1.0 ± 1.5 (P = 0.021), respectively. After a median follow-up period of 24 months (range, 4-169 months), the recurrence-free survival of the PD group was superior to that of the BDR group (P = 0.035). In the patients with LN metastases, the patients undergoing PD had significantly better survival than the BDR group (P < 0.001).
CONCLUSION
Surgeons should be cautious in deciding to perform BDR for middle and distal common bile duct cancer. PD is recommended if LN metastases are suspected.

Keyword

Cholangiocarcinoma; Common bile duct neoplasms; Pancreaticoduodenectomy; Recurrence; Survival

MeSH Terms

Bile Duct Neoplasms
Bile Ducts*
Bile*
Cholangiocarcinoma
Common Bile Duct Neoplasms
Common Bile Duct*
Follow-Up Studies
Humans
Lymph Nodes
Neoplasm Metastasis
Pancreaticoduodenectomy*
Recurrence
Retrospective Studies
Surgeons

Figure

• 

  Fig. 1 Flow diagram of patients with extrahepatic cholangiocarcinoma.

• 

  Fig. 2 Kaplan-Meier survival curves between bile duct resection group and pancreatoduodenectomy group. (A) Disease free survival (n = 89). (B) Overall survival (n = 89). (C) No lymph node metastases (n = 89). (D) Lymph node metastases (n = 89). (E) R0 resection (n = 77). (F) R1 resection (n = 12).

• 

  Fig. 3 The difference between BRD and PD group of recurrent rate and recurrent pattern according to N staging. BDR, bile duct segmental resection; PD, pancreatoduodenectomy.

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