Comparison of pancreaticoduodenectomy and bile duct resection for middle bile duct cancer: A multi‐center collaborating study of Japan and Korea. (11th March 2020)

• Record Type: Journal Article
• Authors: Hayashi, Hiroki; Jang, Jin‐Young; Kim, Kyung Sik; Choi, Jin Sub; Takahara, Takeshi; Choi, Sung Hoon; Hirano, Satoshi; Yu, Hee Chul; Uemura, Syuichiro; Unno, Michiaki
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 27:Number 6(2020)
• Page Start: 289
• Page End: 298
• Publication Date: 2020-03-11
• Subjects: middle bile duct cancer -- pancreaticoduodenectomy -- bile duct segmental resection -- extrahepatic cholangiocarcinoma; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.724
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: It is currently unknown whether bile duct segmental resection (BDSR) is an acceptable method for localized middle bile duct cancer (mid‐BDC) when R0 resection can be achieved. This study aimed to investigate the short‐ and long‐term outcomes of mid‐BDC patients treated with pancreaticoduodenectomy (PD) compared to those for BDSR. Methods: This was a retrospective, Japanese and Korean multi‐center collaboration study based on patients' medical records. Results: A total of 663 patients, including 245 BDSR and 418 PD cases, were enrolled. The incidence of postoperative pancreatic fistula (3.3% vs 44.1%, P < .0001), surgical site infection in the organ space (6.1% vs 17.7%, P < .0001) and clinically problematic morbidities (15.9% vs 32.8%, P < .0001) was significantly higher in the PD group. There was no difference in the mortality rate (0.8% vs 1.7%, P = .3566). Local (33.9% vs 14.4%, P < .0001) and lymph node (22.4% vs 11.0%, P < .0001) recurrence rates were significantly higher in the BDSR group. Relapse‐free survival (25.0 vs 34.0 months, P = .0184) and overall survival (41.2 vs 60.1 months, P = .0019) were significantly longer in the PD group. The PD group had significantly better prognosis in stage IA/IB cases (58.3 vs 111.5 months, P = .0067), which were the best indicators for BDSR, even when R0 resection was achieved. In multivariate analysis, BDSR was an independent poor prognostic factor. Conclusion: Despite the inferior perioperative short‐term outcomes, our data advocate that PD should be the standard procedure for mid‐BDCs and that BDSR should be avoided even if R0 resection can be achieved. (UMIN000017914). Abstract : Highlight This retrospective Japanese and Korean multicenter collaborative study investigated the short‐ and long‐term outcomes of patients with localized middle bile duct cancer, comparing those treated with pancreaticoduodenectomy with those treated with bile duct segmental resection. Hayashi and colleagues concluded that pancreaticoduodenectomy should be the standard procedure for middle bile duct cancer.