title: Extended extrahepatic bile duct resection to avoid performing pancreatoduodenectomy in patients with mid bile duct cancer.
abstract: OBJECTIVE
  Since proximal-to-mid bile duct (BD) cancers often involve the proximal portion of the intrapancreatic BD, resection of the extrahepatic BD can result in a tumor-positive distal resection margin. It is essential that a surgical procedure is developed to obtain a tumor-free distal BD resection margin during extrahepatic BD resection, in which R0 resection can be achieved without performing pancreatoduodenectomy.
  
  
  METHODS
  Based on preparatory clinicopathological analyses, excavation of the proximal intrapancreatic BD was designed to resemble a 2- to 3-cm-long funnel. The surgical procedure was a combination of the usual extrahepatic BD resection and funnel-shaped excavation of the proximal intrapancreatic BD.
  
  
  RESULTS
  This unique procedure, called extended extrahepatic BD resection, was performed on 3 patients aged over 70 years with mid BD cancer. Deep intrapancreatic BD excavation per se required about 1 h. A tumor-free intrapancreatic BD resection margin was obtained in all 3 patients. Only minor complications occurred. Two patients are doing well without recurrence, at 20 and 14 months, respectively, and one is alive at 12 months with lymph node metastasis detected 1 month earlier.
  
  
  CONCLUSIONS
  By achieving R0 resection, this extended extrahepatic BD resection seems to benefit some proximal-to-mid BD cancer patients in whom pancreatoduodenectomy has a high operative risk.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy