Treatment of mid-bile duct carcinoma: Local resection or pancreatoduodenectomy?
| Autor: | Olivier R. Busch, Anton F. Engelsman, Marc G. Besselink, Thomas M. van Gulik, Joanne Verheij, A. Marthe Schreuder, Stijn van Roessel |
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| Přispěvatelé: | Graduate School, Surgery, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Pathology |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Local resection medicine.medical_treatment 030230 surgery Bile Duct Carcinoma Gastroenterology Disease-Free Survival Pancreaticoduodenectomy Cholangiocarcinoma 03 medical and health sciences 0302 clinical medicine Postoperative Complications Bile Ducts Extrahepatic Internal medicine medicine Humans Mortality Lymph node Aged Retrospective Studies Tumor size Bile duct business.industry General Medicine Middle Aged Survival Rate Biliary Tract Surgical Procedures medicine.anatomical_structure Oncology Bile Duct Neoplasms 030220 oncology & carcinogenesis Resection margin Lymph Node Excision Surgery Lymphadenectomy Female Lymph business |
| Zdroj: | European journal of surgical oncology. W.B. Saunders Ltd |
| ISSN: | 0748-7983 |
| Popis: | Introduction: Whereas distal cholangiocarcinoma (DC) is treated by pancreatoduodenectomy (PD), consensus is lacking on treatment of mid-bile duct carcinoma (mid-BDC) without involvement of the pancreatic head. Both PD or a local resection (LR) of the extrahepatic bile duct with lymphadenectomy are being used. The aim of this study was to compare outcomes after PD and LR for mid-BDC and, for reference, PD for DC. Methods: Retrospective monocenter study including consecutive patients who underwent LR for mid-BDC (LR), PD for mid-BDC (PD-mid) and PD for DC (PD-distal) between 2000 and 2016. Clinicopathologic characteristics, postoperative outcomes and survival were compared. Results: A total of 184 patients were included (LR, 22; PD-mid, 38; PD-distal, 124). Postoperative mortality was 0% following LR, 5% (2/22) for PD-mid and 3% (4/124) for PD-distal, p = 0.542. Major complications occurred in 5/22 patients (23%), 19/39 (50%) and 46/124 (37%) respectively, p = 0.103 (LR versus PD-mid, p = 0.038). Tumor size, differentiation grade and resection margin status were comparable across groups. Median number of resected lymph nodes was 5 (range 3–7), 9 (7–14) and 12 (8–16) respectively, p < 0.001. Median overall survival was 46 months (95%CI 10–82), 19 months. (95%CI 11–27), and 29 months (95%CI 23–35) respectively, p = 0.39 (LR versus PD-mid, p = 0.20). Disease-free survival also did not differ. Conclusion: LR is an acceptable treatment for selected patients with mid-BDC, showing less morbidity and comparable survival despite smaller lymph node retrieval. |
| Databáze: | OpenAIRE |
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