Comparison of pancreaticoduodenectomy and bile duct resection for middle bile duct cancer: A multi-center collaborating study of Japan and Korea.

Hiroki Hayashi,Jin Sub Choi,Jin‐Young Jang,Takeshi Takahara,Syuichiro Uemura,Michiaki Unno,Sung Hoon Choi,Kyung Sik Kim,Hee Chul Yu,Satoshi Hirano

doi:10.1002/jhbp.724

Abstract

BackgroundIt 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.MethodsThis was a retrospective, Japanese and Korean multi‐center collaboration study based on patients' medical records.ResultsA 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.ConclusionDespite 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).

Highlights

Curative resection without any cancer remnants (R0 resection) is considered to be essential for the cure of distal bile duct cancer (BDC)
Another Korean group reported that, though the R0 resection rate was higher in the PD group than in the bile duct segmental resection (BDSR) group, there was no significant difference in the prognosis of middle bile duct cancer (mid-BDC) patients between the BDSR and PD groups when R0 resection was achieved
The proportion of patients with pathological T2 cancer and below was higher in the BDSR group, and the proportion of the patients with pT2 and above was higher in the PD group; the rate of pT2 cases was highest in both groups (BDSR 60.4%, PD 44.7%)

Summary

Introduction

Curative resection without any cancer remnants (R0 resection) is considered to be essential for the cure of distal bile duct cancer (BDC). The authors of this study concluded that BDSR could be justified as an alternative radical operation for mid-BDC in a select group of patients with no adjacent organ invasion and negative resection margin. Another Korean group reported that, though the R0 resection rate was higher in the PD group than in the BDSR group, there was no significant difference in the prognosis of mid-BDC patients between the BDSR and PD groups when R0 resection was achieved. 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)

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