Hepatic resection for liver metastases from carcinomas of the distal bile duct and of the papilla of Vater
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- Kurosaki, I., Minagawa, M., Kitami, C. et al. Langenbecks Arch Surg (2011) 396: 607. doi:10.1007/s00423-011-0752-4
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Hepatectomy for liver metastasis from carcinomas of the distal bile duct (BDC) and of the papilla of Vater (PVC) has not been studied in detail. The purpose of this study is to analyze risk factors of liver metastasis and to evaluate outcome of hepatectomy for liver metastasis.
Risk factors of liver metastasis were analyzed in 122 patients who underwent pancreaticoduodenectomy for BDC or PVC. In addition, 13 patients who underwent hepatectomy were reviewed.
Liver metastasis after pancreaticoduodenectomy occurred in 33.8% of BDC and 26.3% of PVC patients. Multivariate analyses revealed that microvenous invasion was a significant risk factor common to BDC and PVC (p ≤ 0.05). However, 4 of the 13 resected cases survived more than 5 years (5-year survival rate, 44.9%). All four long-term survivors underwent margin-negative hepatectomy for a solitary metastasis and were given postoperative adjuvant chemotherapy. Margin-positive hepatectomy in four patients resulted in early re-recurrence of tumor. Limited hepatectomy (three cases) provided margin-positive surgery.
Hepatectomy for a solitary metastasis is the treatment of choice even after pancreaticoduodenectomy, but indication of hepatectomy for multiple metastases is still limited. The combination of surgery and adjuvant chemotherapy should be studied further to improve survival rates.