Clinical

Surgical approach to hilar bile duct cancer tied to zero operative mortality

Last Updated: 2003-08-11 11:19:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Extended hemihepatectomy can be a curative procedure for hilar bile duct cancer, but it is often linked with high morbidity and mortality. Now, Japanese researchers report on a surgical strategy that appears safe and can result in zero operative mortality.

"Although long-term results for resectional surgery for hilar bile duct cancer have been improving over the last 10 years, there have been no studies reporting predominantly major hepatectomies with zero mortality," the investigators note.

The approach, which was developed by Dr. Masatoshi Makuuchi and colleagues, from the University of Tokyo, involves a standard extended hemihepatectomy with removal of the extrahepatic bile duct. However, the key to the approach's success may involve the preoperative preparation -- a special algorithm was created to determine when biliary drainage, portal embolization, both, or neither were indicated.

The new findings, which are published in the July issue of the Annals of Surgery, are based on a study of 58 patients with hilar bile duct cancer.

Thirty-nine patients underwent biliary drainage and 31 patients underwent portal embolization. Extended right and left hemihepatectomies were performed in 27 and 22 patients, respectively, and hepatoduodenopancreatectomies were performed in 9 patients.

None of the patients developed postoperative liver failure and the operative mortality rate was 0%. The morbidity rate was 43% with the most common complication being cholangitis (6 patients).

The overall 5-year survival rate was 40%, the authors note. On multivariate analysis, lymph node involvement was the only significant predictor of survival. The delay in surgical resection due to preoperative preparation did not adversely affect long-term survival.

"Although lymph node involvement is the strongest prognostic factor, surgeons should aim at complete clearance of the tumor with an adequate surgical margin for better long-term survival," the investigators conclude.

Ann Surg 2003;238:73-83.