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KMID : 0371319950480040524
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Journal of the Korean Surgical Society
1995 Volume.48 No. 4 p.524 ~ p.530
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In Carcinoma of hepatic Hilus, will Resection Leaving Microscopically Tumor-positive Margins Result in a Reasonable Palliation?
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Abstract
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Curative resection of hilar bile duct carcinoma is rather difficult because tumor has a storng propensity for spreading along mucosalor submucosal layer of bile duct bothproximally and distally and as well as infiltranting surrounding vital
structures
such as hepatic artery and portal vein. Therefore, even when hepatic resection, with or without major vessel resection, is combined, residual microscopic disease is often left at resection margins. In recent years. However, there has been growing
support for this aggressive resectional approach since patients with microscopically positive margins of resection fared equally well as patients undergoing complete curative resection. Beginning in January 1988, we have attempted to resect all
bile
duct tumors where gross disease could be removed, even if it was known that microscopic tumor remained at resection margins. Six of nine resected specimens had microscopic tumor involvement at surgical resection margins between January 1988 and
June
1990. Morbidity and mortality associated with resection did not occurred in any of these six patients. Microscopic residual cancer did never provoke risk of arly complications related to poor healing of bilioenteric anastomosis. Leakage, abscess
formation, sepsis. Long-term survival and life quality of patients submitted to these so-called palliative resection far edxceeded that of patients submitted to bynass and operative intubation all of these six palliative resection group died of
local
recurrence and bone metastasis at 39, 16, 27, 30 and 17 month after resection. In conclusion, hilar cholangiocarcinoma is best treated by resection whenever possible, even when this necessitates leaving microscopic tumor at resection margin.
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