Multidetector computed tomography for preoperative prediction of postsurgical prognosis of patients with extrahepatic biliary cancer.

BACKGROUND

Preoperative prognostic information to select a treatment strategy is important especially in patients who need highly aggressive surgery, such as those with biliary cancer. We evaluated various prognostic factors and non-curative surgical factors using multidetector computed tomography (MDCT).

METHODS

We retrospectively analyzed 71 patients who underwent MDCT preoperatively and were scheduled for surgical resection of biliary cancer. For MDCT diagnosis, we used MDCT-based classification equivalent to the surgical and pathological classification of the Japanese Society of Biliary Surgery. We evaluated MDCT-related prognostic factors and non-curative surgical factors and compared these factors with pathological results.

RESULTS

MDCT-diagnosed category T (primary tumor invasion) included both prognostic factors and non-curative surgical factors but not category N (lymph node metastasis). Multivariate analysis identified MDCT-based suspected arterial invasion as an independent prognostic factor. In patients suspected of arterial invasion by MDCT, the 3-year overall survival rate was only 39% and the curative resection ratio was only 33%, because of the high positive surgical dissected margin.

CONCLUSION

MDCT-based suspected arterial invasion is a predictor of poor prognosis after surgery for biliary cancer and represents a non-curative surgical factor associated with positive dissected margin.