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KMID : 0870420130170030109
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2013 Volume.17 No. 3 p.109 ~ p.112
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Technical knacks and outcomes of extended extrahepatic bile ductresection in patients with mid bile duct cancer
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Lee Seung-Jae
Hwang Shin
Ha Tae-Yong
Kim Ki-Hun
Ahn Chul-Soo
Moon Deok-Bog
Song Gi-Won
Jung Dong-Hwan
Park Gil-Chun
Lee Sung-Gyu
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Abstract
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Backgrounds/Aims: Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extra-hepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgi-cal procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection.
Methods: We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a ≥2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years.
Results: The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively.
Conclusions: We suggest that extended EHBD resection can be performed as a beneficial option to ach-ieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome.
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KEYWORD
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Bile duct cancer, Extended bile duct resection, Pancreaticoduodenectomy, Resection margin
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