Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Adam R, Chiche L, Aloia T et al (2006) Association Française de Chirurgie. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1, 452 patients and development of a prognostic model. Ann Surg 244:524–535
Yamamoto J, Sugihara K, Kosuge T et al (1995) Pathologic support for limited hepatectomy in the treatment of liver metastases from colorectal cancer. Ann Surg 221:74–78
Riopel MA, Klimstra DS, Godellas CV, Blumgart LH, Westra WH (1997) Intrabiliary growth of metastatic colonic adenocarcinoma: a pattern of intrahepatic spread easily confused with primary neoplasia of the biliary tract. Am J Surg Pathol 21:1030–1036
Todoroki T, Kawamoto T, Koike N et al (2001) Treatment strategy for patients with middle and lower third bile duct cancer. Br J Surg 88:364–370
Cheng Q, Luo X, Zhang B, Jiang X, Yi B, Wu M (2007) Distal bile duct carcinoma: prognostic factors after curative surgery. A series of 112 cases. Ann Surg Oncol 14:1212–1219
Sasaki R, Takahashi M, Funato O et al (2001) Prognostic significance of lymph node involvement in middle and distal bile duct cancer. Surgery 129:677–683
Takao S, Shinchi H, Uchikura K, Kubo M, Aikou T (1999) Liver metastases after curative resection in patients with distal bile duct cancer. Br J Surg 86:327–331
Woo SM, Ryu JK, Lee SH et al (2007) Recurrence and prognostic factors of ampullary carcinoma after radical resection: comparison with distal extrahepatic cholangiocarcinoma. Ann Surg Oncol 14:3195–3201
de Castro SM, Kuhlmann KF, van Heek NT et al (2004) Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy. J Gastrointest Surg 8:775–784
Hsu HP, Yang TM, Hsieh YH, Shan YS, Lin PW (2007) Predictors for patterns of failure after pancreaticoduodenectomy in ampullary cancer. Ann Surg Oncol 14:50–60
Kim RD, Kundhal PS, McGilvray ID et al (2006) Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg 202:112–119
Todoroki T, Koike N, Morishita Y et al (2003) Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 10:1176–1183
Jang JY, Kim SW, Park DJ et al (2005) Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg 241:77–84
Takada Y, Otsuka M, Seino K et al (2001) Hepatic resection for metastatic tumors from noncolorectal carcinoma. Hepatogastroenterology 48:83–86
Sugimoto M, Takada T, Yasuda H et al (2005) Exceptional ultra-late recurrence of papilla Vater carcinoma after pancreaticoduodenectomy: two cases at 17 and 25 years. Hepatogastroenterology 52:940–943
Okusaka T, Nakachi K, Fukutomi A et al (2010) Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer 103:469–474
Sano T, Nimura Y, Hayakawa N et al (1997) Partial hepatectomy for metastatic seeding complicating pancreatoduodenectomy. Hepatogastroenterology 44:263–267
Kitami CE, Kurosaki I, Koyama Y et al (2005) Long-term survival after hepatectomy for hepatic recurrence of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 12:321–323
Sasaki R, Takeda Y, Hoshikawa K et al (2004) Resection of liver metastasis from extrahepatic bile duct carcinoma previously treated by pancreatoduodenectomy. Hepatogastroenterology 51:245–246
Fujii K, Yamamoto J, Shimada K, Kosuge T et al (1999) Resection of liver metastases after pancreatoduodenectomy: report of seven cases. Hepatogastroenterology 4628:2429–2433
de Jong MC, Tsai S, Cameron JL et al (2010) Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. J Surg Oncol 102:256–263
Valle J, Wasan H, Palmer DH et al (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362:1273–1281
Kurosaki I, Hatakeyama K (2005) Repeated hepatectomy for recurrent intrahepatic cholangiocarcinoma: report of two cases. Eur J Gastroenterol Hepatol 17:125–130
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Kurosaki, I., Minagawa, M., Kitami, C. et al. Hepatic resection for liver metastases from carcinomas of the distal bile duct and of the papilla of Vater. Langenbecks Arch Surg 396, 607–613 (2011). https://doi.org/10.1007/s00423-011-0752-4
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DOI: https://doi.org/10.1007/s00423-011-0752-4