[Indications for combined resection and reconstruction of the hepatic artery in biliary tract carcinoma].
More than 10 years have passed since hepatic artery resection was first performed for the treatment of biliary tract cancer. The safety of this procedure has been established with the introduction of the microsurgery technique. However, the benefits of and indications for this treatment have not yet been clarified. Twenty-three patients underwent vascular resection (portal vein in 7, portal vein + hepatic artery in 9, hepatic artery in 7) among 114 resected patients with biliary tract cancer in our institution. The right hepatic artery was reconstructed by end-to-end anastomosis in most cases. The curative resection rate was 88.9% in hilar bile duct cancer. However, it was less than 50% in other carcinomas. Cumulative 5-year survival rates of vascular resection patients with hilar bile duct cancer, lower bile duct cancer, gallbladder cancer, and cholangiocarcinoma were 14.8%, 25%, 0%, and 0%, respectively. On the other hand, the rates were 38.9%, 0%, 0%, and 0%, in the stage III + IV patients who did not undergo vascular resection. The longest survival period among patients with hilar bile duct cancer and lower bile duct cancer was 85 months and 65 months, respectively, whereas it was 15 months in gallbladder cancer and 20 months in cholangiocarcinoma patients. No hilar bile duct cancer patient who survived for more than 3 years had lymph node metastasis. The longest surviving cholangiocarcinoma patient has received adjuvant chemotherapy consisting of 5-fluorouracil and cisplatin. It is concluded that patients with hilar bile duct cancer are good candidates for vascular resection. Adjuvant chemotherapy should be administered to gallbladder cancer and cholangiocarcinoma patients, because vascular resection alone does not result in prolongation of life in these patients.
Endo
I
I
Second Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Masunari
H
H
Sugita
M
M
Morioka
D
D
Tanaka
K
K
Togo
S
S
Sekido
H
H
Yoshida
T
T
Shimada
H
H
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate