Prognostic factors for radical resection of middle and distal bile duct cancer.

BACKGROUND/AIMS: Prognostic factors after radical operation for middle and distal bile duct cancer are not fully understood. The aim of this study is to identify prognostic factors for patients undergoing radical operation for middle and distal bile duct cancer.

METHODOLOGY: The records of 57 patients with middle (n=22) and distal (n=35) bile duct cancer who had undergone radical surgery were reviewed (pancreaticoduodenectomy in 46 patients, extrahepatic bile duct resection in 6, and major hemihepatectomy in 5). The clinicopathological prognostic factors affecting survival were examined.

RESULTS

The 5 years survival rate was 36% (median survival time, 34 months). Significant prognostic factors according to univariate analysis include pT classification, papillary type, number of metastatic lymph node, positive radial margin, pancreatic invasion, lymphatic invasion, venous invasion, common hepatic node metastasis, paraaortic node metastasis, and combined vascular resection. Independent significant prognostic factors according to multivariate analysis include the number of metastatic lymph nodes (5 or more), positive radial margin, and common hepatic node metastasis.

CONCLUSIONS

The number of metastatic lymph nodes, common hepatic node metastasis, and positive radial margin are independent prognostic factors for middle and distal bile duct cancer. The surgical treatment of middle and bile duct cancer should achieve a negative radial margin for a favorable outcome.