Bile duct segmental resection versus pancreatoduodenectomy for middle and distal common bile duct cancer

Purpose: To compare survival outcomes between bile duct segmental resection (BDR) and pancreatoduodenectomy (PD) for the treatment of middle and distal bile duct cancer. Methods: From 1997 to 2013, a total of 96 patients who underwent curative intent surgery for middle and distal bile duct cancer were identified. The patients were divided into 2 groups based on the type of operation; 20 patients were included in the BDR group and 76 patients were in the PD group. We retrospectively reviewed the clinical outcomes. Results: The number of lymph nodes (LNs) was significantly greater in patients within the PD group compared to the BDR group. The total number of LNs was 6.5 +/- 8.2 vs. 11.2 +/- 8.2 (P = 0.017) and the number of metastatic LNs was 0.4 +/- 0.9 vs. 1.0 +/- 1.5 (P = 0.021), respectively. After a median follow-up period of 24 months (range, 4-169 months), the recurrence-free survival of the PD group was superior to that of the BDR group (P = 0.035). In the patients with LN metastases, the patients undergoing PD had significantly better survival than the BDR group (P < 0.001). Conclusion: Surgeons should be cautious in deciding to perform BDR for middle and distal common bile duct cancer. PD is recommended if LN metastases are suspected.