Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

Background: Pancreaticoduodenectomy(PD) is a standardized strategy for patients with middle and distal bile duct cancers. The aim of this study was to compare clinicopathological features of bile duct segmental resection(BDR) with PD in patients with extrahepatic cholangiocarcinoma. Methods: Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR( n = 21) or PD( n = 84) with achievement of R0 or R1 resection in Kobe University Hospital between January 20 0 0 and December 2016 were enrolled in the present study. Results: Patients who underwent PD were significantly younger than those receiving BDR. The frequency of preoperative jaundice, biliary drainage and cholangitis was not significantly different between the two groups. The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs. 421 min, and 770 vs. 402 m L; both P < 0.01). More major complications( > ClavienDindo IIIa) were observed in the PD group(46% vs. 10%, P < 0.01). Postoperative hospital stay was also longer in that group(30 vs. 19 days, P = 0.02). Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33% in BDR and 48% in PD, P = 0.24). The rate of R0 resection was significantly higher in the PD group(80% vs. 38%, P < 0.01). Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62% vs. 38%, P = 0.04). Although 5-year overall survival rates were similar in both groups(44% for BDR and 51% for PD, P = 0.72), in patients with T1 and T2, the BDR group tended to have poorer prognosis(44% vs. 68% at 5-year, P = 0.09). Conclusions: BDR was comparable in prognosis to PD in middle bile duct cancer. Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.