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KMID : 0870420110150010042
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2011 Volume.15 No. 1 p.42 ~ p.49
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Comparison of Survival Outcomes following Segmental Bile Duct Resection versus Pancreatoduodenectomy for Mid Bile Duct Cancer
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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
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Abstract
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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.
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KEYWORD
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Bile duct cancer, Recurrence, Pancreatoduodenectomy, Segmental bile duct resection
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