Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma.

Autor: Jikei, Kosuke, Ebata, Tomoki, Mizuno, Takashi, Kyokane, Takanori, Matsubara, Hideo, Yokoyama, Shinya, Kato, Kenji, Suzumura, Kiyoshi, Hashimoto, Mizuo, Kawai, Satoru, Nagino, Masato, the Nagoya Surgical Oncology Group, Aoba, T., Kaneoka, Y., Arai, T., Shimizu, Y., Sugawara, G., Miyake, H., Sakamoto, E., Shirai, K.
Zdroj: Annals of Surgical Oncology: An Oncology Journal for Surgeons; Apr2021, Vol. 28 Issue 4, p1990-1999, 10p
Abstrakt: 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. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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