Influence of Cancer Cell Infiltration at Resection Margin of Hepatic Duct on Prognosis and Treatment of Middle and Lower Bile Duct Carcinoma

Nobutaka Tanaka, Masakazu Nobori, Takatoshi Furuya, Takashi Ueno, Takayuki Kanno, Kouichi Mizuta, Yoshihiro Sakamoto, Tomohiro Murakawa

Department of Surgery, Asahi General Hospital

Whether or not a microscopically tumor-positive resection margin of the hepatic duct (hw(+)) affects the postresectional long-term prognosis was studied in 28 cases of middle and lower bile duct cancer resected during the past 15 years (1978-1993). hw (+) was identified in 10 cases, or 36% of all cases. The pathological background was not different between hw (+) cases and those with a tumor-negative resection margin (hw (+)) except in d-factor. The five year survival rates of 30% in hw (+) and 43.8% in hw (+) were not significantly different. Intraoperative frozen section in 10 hw (+) cases was positive in 6, and negative in 4. Long-term survivors of more than 5 years numbered 6 in this series, and included 3 hw (+) patients. Recurrence in long-term survivors, irrespective of hw positive or negative status, was characterized by anastomotic recurrence, while short-term survivors died exclusively of distant metastases and peritonitis carcinomatosa. These results indicated that hw (+) is not a prognostic factor for the treatment of bile duct cancer. Since recurrence in short-term survivors seems not to be influenced by hw (+) as well, radical operation should be balanced with progression of the disease and curativity of the operation.

Key words
middle and lower bile duct cancer, longterm survivor of bile duct cancer, resection margin of hepatic duct

Reprint requests
Nobutaka Tanaka Department of Surgery, Asahi General Hospital
i-1326 Asahi, Chiba, 289-25 JAPAN

Accepted
March 8, 1995

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