Clinicopathological Study on the Long Term Survivors Following Resection of Hilar Bile Duct Cancer

Takeshi Todoroki, Toru Kawamoto, Naoto Koike, Kazuo Orii, Masaaki Otsuka, Hiroshi Ueda, Yuichi Kawai, Takao Okamura*, Yoji Iwasaki

Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
*Department of Surgery, Tsukuba Gakuen Hospital

57 patients underwent tumor resection for hilar bile duct cancer and 13 of them received curative and 44 noncurative resection. Out of the 57,9 patients (Stage II, 1; III, 3; IV, 5) have alived for more than 5 years following curative (6), or noncurative (3) resection. Resection procedures for the 9 survivors consisted of hilar bile duct resection (HBDR) for 2 patients, HBDR+pancreatoduodenectomy for one, HBDR+Ext. right hepatic lobectomy+SI resection for one and HBDR+Ext. left hepatic lobectomy +/- SI resection for 5 patients. Examination for extent of cancer invasion into the bile duct wall revealed that one had invasion within the adventitia and 4 had invasion into the adjacent organs. In terms of direct extension into the hepatic parenchyma, 4 of 9 (55.6%) had direct extension. While, 3 of 9 patients had lymph node metastasis. Out of the 9 survivors, one had a positive surgical margin at the hepatic duct and 3 had a positive margin at the site opposite the mucosal surface. The incidence of positive margins in the survivors for more than 3 years (n=13) was significantly (p<0.05) lower than that in the patients who dead in less than 3 years (n=36). These results indicate the importance of the negative margins in achieving long term survival following tumor resection.

Key words
hilar bile duct cancer, clinicopathological study on the long term survivors, more than 5 years survivors

Reprint requests
Takashi Todoroki Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
1-1-1 Tennoudai, Tsukuba-shi, 305 JAPAN

Accepted
March 13, 1991

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