Technical knacks and outcomes of extended extrahepatic bile duct resection in patients with mid bile duct cancer.
10.14701/kjhbps.2013.17.3.109
- Author:
Seung Jae LEE
1
;
Shin HWANG
;
Tae Yong HA
;
Ki Hun KIM
;
Chul Soo AHN
;
Deok Bog MOON
;
Gi Won SONG
;
Dong Hwan JUNG
;
Gil Chun PARK
;
Sung Gyu LEE
Author Information
1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Bile duct cancer;
Extended bile duct resection;
Pancreaticoduodenectomy;
Resection margin
- MeSH:
Aged;
Bile;
Bile Duct Neoplasms;
Bile Ducts;
Bile Ducts, Extrahepatic;
Hepatic Duct, Common;
Humans;
Pancreatic Juice;
Pancreaticoduodenectomy;
Survival Rate
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2013;17(3):109-112
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUNDS/AIMS: Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extrahepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgical procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection. METHODS: We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a > or =2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years. RESULTS: The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively. CONCLUSIONS: We suggest that extended EHBD resection can be performed as a beneficial option to achieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome.
