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Treatment of mid-bile duct carcinoma: Local resection or pancreatoduodenectomy?
Schreuder, A Marthe; Engelsman, Anton F; van Roessel, Stijn; Verheij, Joanne; Besselink, Marc G; van Gulik, Thomas M; Busch, Olivier R.
Affiliation
  • Schreuder AM; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Engelsman AF; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • van Roessel S; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Verheij J; Department of pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Besselink MG; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • van Gulik TM; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Busch OR; Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: o.r.busch@amsterdamumc.nl.
Eur J Surg Oncol ; 45(11): 2180-2187, 2019 Nov.
Article in En | MEDLINE | ID: mdl-31279596
INTRODUCTION: Whereas distal cholangiocarcinoma (DC) is treated by pancreatoduodenectomy (PD), consensus is lacking on treatment of mid-bile duct carcinoma (mid-BDC) without involvement of the pancreatic head. Both PD or a local resection (LR) of the extrahepatic bile duct with lymphadenectomy are being used. The aim of this study was to compare outcomes after PD and LR for mid-BDC and, for reference, PD for DC. METHODS: Retrospective monocenter study including consecutive patients who underwent LR for mid-BDC (LR), PD for mid-BDC (PD-mid) and PD for DC (PD-distal) between 2000 and 2016. Clinicopathologic characteristics, postoperative outcomes and survival were compared. RESULTS: A total of 184 patients were included (LR, 22; PD-mid, 38; PD-distal, 124). Postoperative mortality was 0% following LR, 5% (2/22) for PD-mid and 3% (4/124) for PD-distal, p = 0.542. Major complications occurred in 5/22 patients (23%), 19/39 (50%) and 46/124 (37%) respectively, p = 0.103 (LR versus PD-mid, p = 0.038). Tumor size, differentiation grade and resection margin status were comparable across groups. Median number of resected lymph nodes was 5 (range 3-7), 9 (7-14) and 12 (8-16) respectively, p < 0.001. Median overall survival was 46 months (95%CI 10-82), 19 months. (95%CI 11-27), and 29 months (95%CI 23-35) respectively, p = 0.39 (LR versus PD-mid, p = 0.20). Disease-free survival also did not differ. CONCLUSION: LR is an acceptable treatment for selected patients with mid-BDC, showing less morbidity and comparable survival despite smaller lymph node retrieval.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Bile Duct Neoplasms / Biliary Tract Surgical Procedures / Pancreaticoduodenectomy / Cholangiocarcinoma / Bile Ducts, Extrahepatic Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Eur J Surg Oncol Journal subject: NEOPLASIAS Year: 2019 Document type: Article Affiliation country: Netherlands Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Bile Duct Neoplasms / Biliary Tract Surgical Procedures / Pancreaticoduodenectomy / Cholangiocarcinoma / Bile Ducts, Extrahepatic Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Eur J Surg Oncol Journal subject: NEOPLASIAS Year: 2019 Document type: Article Affiliation country: Netherlands Country of publication: United kingdom