Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: An analysis of the surgical procedures, Surgical margins, and survivals of 77 patients

Yoshihiro Sakamoto, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Hidenori Ojima, Tsuyoshi Sano, Junji Yamamoto, Tomoo Kosuge

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Optical surgical management of infrahilar/suprapancreatic cholangiocarcinoma remains controversial. Methods: Between 1988 and 2006, 77 patients with infrahilar/suprapancreatic cholangiocarcinoma underwent curative surgical resections following our intention-to-treat strategy. The clinicopathological factors affecting survival were evaluated using univariate and multivariate analyses with regard to the surgical procedures and surgical margins. Results: The surgical procedure included extrahepatic bile duct resection alone (EHBD; n = 17), major hepatectomy combined with extrahepatic bile duct resection (MHx; n = 26), pancreaticoduodenectomy (PD; n = 28), and MHx and concomitant PD (HPD; n = 6). Performance of MHx and/or PD in addition to EHBD increased surgical morbidity (p = 0.001). Among patients undergoing the four surgical procedures (EHBD, MHx, PD, and HPD), no significant difference was found in the incidence of positive overall surgical margins (53%, 65%, 46%, and 67%, p = 0.51) or long-term survivals (median survival time, 51, 27, 41, and 22 months, p = 0.60). A multivariate analysis revealed that perineural invasion (95% confidence interval, 1.1-12.3, p = 0.009), nodal metastasis (1.6-6.8, p = 0.001), and blood transfusion (1.1-3.9, p = 0.02) were independent predictors of a poor outcome. Perineural invasion was associated with positive radial margins (p = 0.045) and submucosal ductal infiltration (p = 0.03). Conclusion: Perineural invasion, rather than the type of surgical procedure, had a significant impact on surgical curability and survival of patients with infrahilar/suprapancreatic cholangiocarcinoma treated according to our intention-to-treat strategy.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number2
DOIs
Publication statusPublished - 2010 Feb 1
Externally publishedYes

Keywords

  • Cholangiocarcinoma
  • Major hepatectomy
  • Pancreaticoduodenectomy
  • Perineural invasion
  • Upper and middle

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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