Surgical management of hilar bile duct cancer. Preoperative diagnosis, selection of treatment options and clinical outcome.
OBJECTIVE
Although the progression of hilar bile duct cancer is slow, without adequate treatment the prognosis becomes poor. Margin-positive or negative resection has often been reported to correlate with the prognosis. Moreover, the value of combined vessel resection for hilar bile duct cancer is still obscure.


METHODS
Fifty-five out of 98 cases of hilar bile duct cancer were treated with surgery. The patients were classified as a microscopic margin-positive resection group with 12 cases and a microscopic margin-negative resection group with 43 cases. The agreement between preoperative diagnosis and pathological findings of resected specimens was examined, as were cumulative survival rates according to clinical and pathological factors.


RESULTS
In diagnosis of portal invasion with computed tomography, the rate of coincidence, overestimate and underestimate were 69.8%, 13.2% and 17.0%, respectively. Corresponding rates in diagnosing arterial invasion were 58.5%, 15.1% and 26.4%, respectively, and for lymph node metastasis 54.7%, 9.4% and 35.8%, respectively. The 5-year survival rates for margin-positive and negative resection groups were 17.9% and 26.5%, respectively (NS). Patients surviving for more than 1 year in the margin-positive resection group tended to exhibit exposed cancer cells only at the bile duct, rarely showing lymph node metastases. Combined arterial resection had a poor prognosis and high, usually lethal, complication rates.


CONCLUSIONS
Accurate preoperative diagnosis rates of vessel invasion and lymph node metastasis were 60-70% and 56%, respectively. The long-term survival was expected even in margin-positive resection cases without lymph node metastasis. Combined hepatic arterial resection showed no clinical advantage.
Hirai
Ichiro
I
First Department of Surgery, Yamagata University School of Medicine, Yamagata, Japan. i-hirai@yf6.so-net.ne.jp
Kimura
Wataru
W
Fuse
Akira
A
Suto
Koichi
K
Sakurai
Fumiaki
F
Ishiyama
Shuichi
S
D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000098:blood supply; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D015996:Survival Rate; D014057:Tomography, X-Ray Computed