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KMID : 0882420080750020194
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Korean Journal of Medicine
2008 Volume.75 No. 2 p.194 ~ p.201
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The effect of curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer
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Kim Jung-Il
Lee Heon-Young
Kim Seok-Hyun
Lee Byung-Seok
Kwon Dae-Soon
Nam Kwan-Woo
Kang Sun-Hyung
Jung Jae-Hoon
Goh Pyung-Gohn
Hwang Se-Woong
Moon Hee-Seok
Sung Jae-Kyu
Ko Kwang-Hun
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Abstract
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Background: 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.
Conclusion: 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. (Korean J Med 75:194-201, 2008)
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KEYWORD
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Extrahepatic bile duct cancer, Radiotherapy, Curative resection
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