Dataset Information

Survival Comparison of Different Operation Types for Middle Bile Duct Cancer: Bile Duct Resection versus Pancreaticoduodenectomy Considering Complications and Adjuvant Treatment Effects.

ABSTRACT:

Background

Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to improve survival. However, the wider the range of surgery, the higher the chance of complications; this, in turn, makes adjuvant treatment impossible. Nevertheless, no definitive surgical strategy considers the possible complication rates and subsequent adjuvant treatment. We aimed to investigate the appropriate surgical type considering the margin status, complications, and adjuvant treatment in MBD cancer.

Materials and methods

From 2008 to 2017, 520 patients diagnosed with MBD cancer at the Samsung Medical Center were analyzed retrospectively according to the operation type, margin status, complications, and adjuvant treatment. The R1 group was defined as having a carcinoma margin.

Results

The 5-year survival rate for patients who underwent R0 and R1 resection was 54.4% and 33.3%, respectively (p = 0.131). Prognostic factors affecting the overall survival were the age, preoperative CA19-9 level, T stage, and N stage, but not the operation type, margin status, complications, or adjuvant treatment. The complication rates were 11.5% and 29.8% in the BDR and PD groups, respectively (p < 0.001). We observed no significant difference in the adjuvant treatment ratio according to complications (p = 0.675). Patients with PD who underwent R0 resection and could not undergo chemotherapy because of complications reported better survival rates than those with BDR who underwent R1 resection after adjuvant treatment (p = 0.003).

Conclusion

The survival outcome of patients with R1 margins who underwent BDR did not match those with R0 margins after PD, even after adjuvant treatment. Due to improvements in surgical techniques and the ability to resolve complications, surgical complications exert a marginal effect on survival. Therefore, surgeons should secure R0 margins to achieve the best survival outcomes.

SUBMITTER: Lim SY

PROVIDER: S-EPMC10814212 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Survival Comparison of Different Operation Types for Middle Bile Duct Cancer: Bile Duct Resection versus Pancreaticoduodenectomy Considering Complications and Adjuvant Treatment Effects.

Lim Soo Yeun SY Alramadhan Hani Jassim HJ Jeong HyeJeong H Chae Hochang H Kim Hyeong Seok HS Yoon So Jeong SJ Shin Sang Hyun SH Han In Woong IW Heo Jin Seok JS Kim Hongbeom H

Cancers 20240110 2

<h4>Background</h4>Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to improve survival. However, the wider the range of surgery, the higher the chance of complications; this, in turn, makes adjuvant treatment impossible. Nevertheless, no definitive sur ...[more]

PMID: 38254787

Similar Datasets

Project description:BackgroundHepatocellular carcinoma (HCC) associated with bile duct tumor thrombus (BDTT) is uncommon in clinical practice. Surgical resection can achieve better survival than non-operative palliative treatments. However, there is great controversy regarding the optimal surgical modality, particularly regarding the approach to remove BDTT in patients with HCC with macroscopic BDTT.MethodsData from consecutive patients who underwent radical surgery for HCC and macroscopic BDTT at the Eastern Hepatobiliary Surgery Hospital and Fujian Provincial Hospital from January 2009 to December 2016 were retrospectively reviewed. The survival outcomes of patients who underwent hepatectomy combined with extrahepatic bile duct resection (the EBDR group) were compared with those of patients undergoing liver resection plus thrombectomy (the thrombectomy group) using propensity score matching (PSM). Univariate and multivariate Cox analyses were performed to identify independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS).Results217 patients included in this study were divided into two groups: the EBDR group (n=30) and the thrombectomy group (n=187). A total of 90 patients were matched by PSM with a 1:2 ratio. Before PSM, the OS and RFS rates were comparable between the two groups (for OS, P=0.517; for RFS, P=0.211). After PSM, the OS rates did not differ statistically significantly between the EBDR and thrombectomy groups (P=0.134). Nevertheless, the RFS rate of the EBDR group was significantly higher compared to that of the thrombectomy group (P=0.020). Multivariate analysis demonstrated that some traditional risk factors, such as tumor size and microscopic resection margin, were more important prognostic factors than the BDTT type.ConclusionsFor patients with HCC and macroscopic BDTT, hepatectomy combined with extrahepatic bile duct resection is associated with a reduced recurrence rate in comparison with concurrent thrombectomy. Further large-scale, prospective studies are warranted to evaluate the impact of different surgical modalities on these patients' survival.

Dataset Information

Survival Comparison of Different Operation Types for Middle Bile Duct Cancer: Bile Duct Resection versus Pancreaticoduodenectomy Considering Complications and Adjuvant Treatment Effects.

Background

Materials and methods

Results

Conclusion

Publications

Survival Comparison of Different Operation Types for Middle Bile Duct Cancer: Bile Duct Resection versus Pancreaticoduodenectomy Considering Complications and Adjuvant Treatment Effects.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets