Original CommunicationIs extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer?
Section snippets
Methods
Between 1989 and 2010, 283 patients with bile duct cancer (excluding intrahepatic cholangiocarcinoma) and 204 patients with gallbladder cancer underwent surgical resection at the Hepatobiliary and Pancreatic Surgery Division, National Cancer Hospital, Tokyo. Of these, 14 patients with widespread bile duct cancer (4.9%) underwent right or left HPD, and 5 patients with gallbladder cancer having biliary infiltration (2.5%) underwent right HPD. One patient underwent right HPD on the preoperative
Surgical outcomes
Right HPD was performed in 17 patients, and left HPD was performed in 2 patients. Of these, HPD was scheduled at the beginning of surgery in 12 patients (7 with bile duct cancer and 5 with gallbladder cancer), according to imaging or intraoperative findings, including palpation of the hepatoduodenal ligament in 4 patients with bile duct cancer. In the remaining 3 patients, HPD proceeded based on the findings in the ductal margins; in 2 patients, extended right hemihepatectomy was performed when
Discussion
The present results showed a remarkable contrast with regard to the prognoses of patients undergoing HPD for bile duct cancer and gallbladder cancer. In 14 patients with bile duct cancer, 11 (79%) had T1 or T2 tumors, and the final stage was I or II in 11 other patients. The radial margin was negative in 93% of these patients, and the overall 5-year survival rate was 45%. In contrast, in 5 patients with gallbladder cancer, all had T4 tumors, and the final stage was IV in all. Biliary
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Supported in part by a grant-in-aid for scientific research from the Ministry of Health and Welfare of Japan and the National Cancer Center Research and Development Fund.