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Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology.

Methods

Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR.

Results

During the study, 92 patients underwent BDR (n = 38) or PD (n = 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (P = 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (P = 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76; P = 0.023] by multivariable analysis. In the BDR group, tumor length < 15 mm (HR, 3.38; P = 0.017) and ductal margin length ≥ 10 mm (HR, 2.54; P = 0.018) were independent positive prognostic factors. Stratified by these two favorable factors, the 5-year survival rate was 63.0% in patients with 1/2 factors and 6.7% in those with 0 factors (P < 0.001).

Conclusion

In patients with MCC, BDR provided a better short-term and a worse long-term outcome than PD. However, patient selection using tumor length and ductal margin length may allow a favorable survival probability even after BDR.

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Acknowledgements

The authors are grateful to the following investigators in the Nagoya Surgical Oncology Group: T. Aoba (Toyohashi Municipal Hospital, Toyohashi), Y. Kaneoka (Ogaki Municipal Hospital, Ogaki), T. Arai (Anjo Kosei Hospital, Anjo), Y. Shimizu (Aichi Cancer Center Hospital, Nagoya), G. Sugawara (Toyota Kosei Hospital, Toyota), H. Miyake (Japanese Red Cross Nagoya Daiichi Hospital, Nagoya), E. Sakamoto (Japanese Red Cross Nagoya Daini Hospital, Nagoya), K. Shirai (Yamashita Hospital, Ichinomiya), Y. Okada (Handa City Hospital, Handa), E. Hayashi (Japan Community Health care Organization Chukyo Hospital, Nagoya), Y. Kato (Nagoya Ekisaikai Hospital, Nagoya), R. Yamaguchi (Kasugai Municipal Hospital, Kasugai), S. Kobayashi (Kumiai Kosei Hospital, Takayama), Y. Uno (Daido Hospital, Nagoya), T. Maeta (JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu), S. Mizuno (Shizuoka Welfare Hospital, Shizuoka), H. Yamamoto (Tokai Hospital, Nagoya), K. Akashi (Hekinan Municipal Hospital, Hekinan), M. Takano (Asahi Rousai Hospital, Owariasahi), M. Uno (Tokoname City Hospital, Tokoname), and M. Hattori (Nishichita General Hospital, Chita).

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kosuke Jikei MD, Tomoki Ebata MD, Takashi Mizuno MD & Masato Nagino MD

  2. Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan

    Takanori Kyokane MD

  3. Department of Surgery, Yachiyo Hospital, Anjo, Japan

    Hideo Matsubara MD

  4. Department of Surgery, Meijo Hospital, Nagoya, Japan

    Shinya Yokoyama MD

  5. Department of Surgery, Inazawa Municipal Hospital, Inazawa, Japan

    Kenji Kato MD

  6. Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan

    Kiyoshi Suzumura MD

  7. Department of Surgery, Chubu-Rosai Hospital, Nagoya, Japan

    Mizuo Hashimoto MD

  8. Department of Surgery, Tsushima City Hospital, Tsushima, Japan

    Satoru Kawai MD

Authors
  1. Kosuke Jikei MD
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  2. Tomoki Ebata MD
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  3. Takashi Mizuno MD
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  4. Takanori Kyokane MD
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  5. Hideo Matsubara MD
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  6. Shinya Yokoyama MD
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  7. Kenji Kato MD
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  8. Kiyoshi Suzumura MD
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  9. Mizuo Hashimoto MD
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  10. Satoru Kawai MD
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  11. Masato Nagino MD
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Consortia

the Nagoya Surgical Oncology Group

  • T. Aoba
  • , Y. Kaneoka
  • , T. Arai
  • , Y. Shimizu
  • , G. Sugawara
  • , H. Miyake
  • , E. Sakamoto
  • , K. Shirai
  • , Y. Okada
  • , E. Hayashi
  • , Y. Kato
  • , R. Yamaguchi
  • , S. Kobayashi
  • , Y. Uno
  • , T. Maeta
  • , S. Mizuno
  • , H. Yamamoto
  • , K. Akashi
  • , M. Takano
  • , M. Uno
  •  & M. Hattori

Corresponding author

Correspondence to Tomoki Ebata MD.

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Jikei, K., Ebata, T., Mizuno, T. et al. Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma. Ann Surg Oncol 28, 1990–1999 (2021). https://doi.org/10.1245/s10434-020-09157-3

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  • DOI: https://doi.org/10.1245/s10434-020-09157-3

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