One hundred and eleven liver resections for hilar bile duct cancer |
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Authors: | Lee S G Lee Y J Park K M Hwang S Min P C |
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Institution: | (1) Department of Surgery, Asan Medical Center, Ulsan University of College Medicine, 388-1 Poong Nap-Dong, Song Pa-Ku, Seoul 138-736, Korea, KR |
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Abstract: | A positive correlation between absence of residual tumor at resection margins and long-term survival in the treatment of
hilar bile duct carcinoma has encouraged some surgeons to use a more radical approach, including liver/portal vein resection
and combined pancreatoduodenectomy. However, if liver resection is associated with significant morbidity and mortality, it
may not produce any overall benefit. This review was undertaken in an attempt to determine whether liver resection is a safe
procedure and whether if has any beneficial effect over that of local bile duct excision alone, in terms of achieving curative
resection and long-term survival. The records of 151 patients with hilar bile duct carcinoma surgically treated between June
1989 and December 1997 at the Asan Medical Center, Seoul, were retrospectively analyzed. Surgical resection was possible in
128 patients. The remaining 23 patients had surgical palliative drainage. Local bile duct excision alone was performed in
17 patients. Liver resection for tumor extending to secondary bile ducts or hepatic parenchyma was performed in 111 patients;
portal vein resection was necessary in 29 of these 111 patients (26.1%) and pancreatoduodenectomy was combined in 18 patients
(16.2%). Seven patients died during hospitalization after liver resection, an operative mortality of 6.3%. Margins of bile
duct resection were free of tumor on histologic examination in 4 of the 17 local bile duct excisions, but in 86 of the 111
liver resections. The cumulative survival rate after local bile duct excision was 85.7% at 1 year, 42.9% at 2 years, 21.4%
at 3 years, and 0% at 4 years. However, the survival rate after liver resection (excluding operative mortality) was 97.1%
at 1 year, 72.8% at 2 years, 55.3% at 3 years, and 24.0% at 5 years. Survival and the percentage of patients with tumor-free
resection margins after liver resection were superior to those after local bile duct excision. Resection of hilar bile duct
carcinoma offers long-term survival only when surgery is aggressive and includes liver resection.
Received for publication on July 2, 1998; accepted on July 5, 1998 |
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Keywords: | : hilar bile duct cancer liver resection |
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