Surgical Treatment for Middle and Lower Bile Duct Carcinoma

Seiki Matsuno

First Department of Surgery, Tohoku University School of Medicine

The surgical outcome of 99 patients with resected middle (Bm) and lower (Bi) bile duct carcinomas was reviewed in order to clarify the radicalities of the two surgical procedures employed for their treatment, namely, the standard pancreato-duodenectomy (PD) for Bi carcinoma and bile duct resection with D₂ lymph node dissection for Bm carcinoma. The overall 5-year cumulative survival rate (operative death excluded) of Bm and Bi carcinoma patients was 37.4%, and the 5-year survival rate of the patients who accomplished surgical curability (Cur) A was 51.6%. Recently, a new prognostic factor, t which indicates the degree of the pericholedochal neoplasic invasion was proposed in the fourth edition of the general rules for surgical and pathological studies on cancer of the biliary tract. The 10-year survival rates by t-degree were 49.1% (t₁), 19.7% (t₂) and 0% (t₃ and t₄) respectively. For Bm carcinoma, the patients undergoing bile duct resection under the condition of Cur A attained excellent prognoses. For Bi carcinoma, the patients fulfilling particular histological findings, namely, histological depth of neoplasic invasion (m, fm, panc_1a), duodenal involvement (du₀, du₁), vascular invasion (pv₀), pericholedocal neoplasic invasion (t₁), lymph node metastasis (n₀), and comprehensive stage I, had good postoperative outcomes. Taking into account that the metastatic rate of paragastric lymph nodes was 1.3%, the cases of panc_0,1 should be operated by pylorus preserving PD (PpPD). The overall 5-year survival rates, including far advanced cases were 39.9% in Bm carcinoma patients, and 36.9% in Bi carcinoma patients. However, these postoperative outcomes are not deeply satisfying. Therfore, we concluded that PD amd PpPD with extended D₃ lymphadenectomy combined with systematic multimodality therapy were needed in each and every case of Bm and Bi carcinoma.

Key words
middle and lower bile duct carcinoma, bile duct resection, pancreatoduodenectomy

Reprint requests
Seiki Matsuno The First Department of Surgery, Tohoku University School of Medicine 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
November 13, 1998

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