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Takanori Yoshida, MD; Toshifumi Matsumoto, MD; Atsushi Sasaki, MD; Yuji Morii, MD; Masanori Aramaki, MD; Seigo Kitano, MD

Arch Surg. 2002;137:69-73.

Background  Since 1995, we have been performing pancreatoduodenectomy with regional and para-aortic lymph node dissection for patients with distal bile duct cancer. Prognostic indicators after extended lymphadenectomy have not been fully understood.

Hypothesis  Pancreatoduodenectomy with extended lymphadenectomy and adjuvant chemotherapy is the treatment of choice for patients with distal bile duct cancer.

Design  In a retrospective study, univariate and multivariate models were used to analyze the effect of patient demographics, tumor characteristics, and treatment factors on long-term survival.

Setting  Oita Medical University and its affiliated hospitals in Japan.

Patients  From 1995 to 1999, 27 patients with distal bile duct cancer underwent pancreatoduodenectomy with extended lymphadenectomy. In 9 patients fluorouracil (500 mg/d) was infused continuously for 14 days after surgery as adjuvant chemotherapy.

Main Outcome Measures  Clinicopathologic characteristics and long-term results.

Results  In 6 patients (22%) major surgical complications occurred including 1 in-hospital death (3.7%). For 26 patients, the survival rates were 65% for 1 year and 37% for 3 and 5 years. Univariate analysis found that the absence of lymph node metastasis, no more than 2 involved nodes, and negative resection margins were predictors of survival. Multivariate analysis with a Cox proportional hazards regression model revealed that favorable factors for survival included up to 2 positive nodes, negative resection margins, and the use of postoperative adjuvant chemotherapy.

Conclusions  Patients with up to 2 positive lymph nodes had a more favorable prognosis than that of other patients. We recommend pancreatoduodenectomy with extended lymphadenectomy and adjuvant chemotherapy for the treatment of patients with distal bile duct cancer.

From the Department of General Surgery, Nakatsu Municipal Hospital (Drs Yoshida and Morii), and the First Department of Surgery, Oita Medical University (Drs Matsumoto, Sasaki, Aramaki, and Kitano), Oita, Japan.

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