TY - JOUR
T1 - Comparison of pancreaticoduodenectomy and bile duct resection for middle bile duct cancer
T2 - A multi-center collaborating study of Japan and Korea
AU - Hayashi, Hiroki
AU - Jang, Jin Young
AU - Kim, Kyung Sik
AU - Choi, Jin Sub
AU - Takahara, Takeshi
AU - Choi, Sung Hoon
AU - Hirano, Satoshi
AU - Yu, Hee Chul
AU - Uemura, Syuichiro
AU - Unno, Michiaki
N1 - Funding Information:
We appreciate all the facilities and collaborators of Japan and Korea that provided the valuable data. We thank Hiroki Yamaue, Wakayama Medical University, Masakazu Yamamoto, Tokyo Women's Medical University, and Sohei Satoi, Kansai Medical University, for suggesting the topics and giving us shrewd and helpful advice. We also thank Chang Moo Kang, Yonsei University for working as a bridge between Japan and Korea, contacting the Korean facility, and for providing information. All participating facilities in Japan and Korea, and the number of cases enrolled are as follows: From Japan, Iwate Medical University (44), Tohoku University (32), Hokkaido University (30), Tokyo Women's Medical University (27), Tokyo Medical and Dental University (18), Oita University (13), Kobe University (12), National Defence Medical College (12), Sapporo Kosei General Hospital (11), Chiba University (10), Jichi Medical University (10), Niigata University (10), Kyushu University (10), Osaka University (9), Hyogo College of Medicine (8), Kanazawa University (8), Kurume University (8), Okayama Saiseikai General Hospital (8), Kumamoto University (7), Sendai Kousei Hospital (7), Jichi Medical University Saitama Medical Center (6), Kochi Health Sciences Center (6), Sapporo Medical University (6), Faculty of Medicine, University of Yamanashi (5), Nagasaki Medical Center (5), Yamaguchi University (5), Fukushima Medical University (4), Kanagawa Cancer Center (4), Kurashiki Central Hospital (4), Hiroshima Prefectural Hospital (4), Fujita Health University (3), Osaka National Hospital (3), Teikyo University (3), Jikei University Hospital (2), Kansai Medical University (2), Kyushu Medical Center (2), Otsu Red Cross Hospital (2), Faculty of Medicine, University of Miiyazaki (2), Tokyo Metropolitan Tama Medical Center (1), Yamagata University (1). From Korea, Seoul National University (59), Yonsei University (57), Cha University (45), Chungbuk National University (39), Keimyung University Dongsan Medical Center (30), Gyeongsang National University (29), Pusan National University (20), Dong-A University (11), Dongguk University (9).
Publisher Copyright:
© 2020 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Background: It is currently unknown whether bile duct segmental resection (BDSR) is an acceptable method for localized middle bile duct cancer (mid-BDC) when R0 resection can be achieved. This study aimed to investigate the short- and long-term outcomes of mid-BDC patients treated with pancreaticoduodenectomy (PD) compared to those for BDSR. Methods: This was a retrospective, Japanese and Korean multi-center collaboration study based on patients' medical records. Results: A total of 663 patients, including 245 BDSR and 418 PD cases, were enrolled. The incidence of postoperative pancreatic fistula (3.3% vs 44.1%, P <.0001), surgical site infection in the organ space (6.1% vs 17.7%, P <.0001) and clinically problematic morbidities (15.9% vs 32.8%, P <.0001) was significantly higher in the PD group. There was no difference in the mortality rate (0.8% vs 1.7%, P =.3566). Local (33.9% vs 14.4%, P <.0001) and lymph node (22.4% vs 11.0%, P <.0001) recurrence rates were significantly higher in the BDSR group. Relapse-free survival (25.0 vs 34.0 months, P =.0184) and overall survival (41.2 vs 60.1 months, P =.0019) were significantly longer in the PD group. The PD group had significantly better prognosis in stage IA/IB cases (58.3 vs 111.5 months, P =.0067), which were the best indicators for BDSR, even when R0 resection was achieved. In multivariate analysis, BDSR was an independent poor prognostic factor. Conclusion: Despite the inferior perioperative short-term outcomes, our data advocate that PD should be the standard procedure for mid-BDCs and that BDSR should be avoided even if R0 resection can be achieved. (UMIN000017914).
AB - Background: It is currently unknown whether bile duct segmental resection (BDSR) is an acceptable method for localized middle bile duct cancer (mid-BDC) when R0 resection can be achieved. This study aimed to investigate the short- and long-term outcomes of mid-BDC patients treated with pancreaticoduodenectomy (PD) compared to those for BDSR. Methods: This was a retrospective, Japanese and Korean multi-center collaboration study based on patients' medical records. Results: A total of 663 patients, including 245 BDSR and 418 PD cases, were enrolled. The incidence of postoperative pancreatic fistula (3.3% vs 44.1%, P <.0001), surgical site infection in the organ space (6.1% vs 17.7%, P <.0001) and clinically problematic morbidities (15.9% vs 32.8%, P <.0001) was significantly higher in the PD group. There was no difference in the mortality rate (0.8% vs 1.7%, P =.3566). Local (33.9% vs 14.4%, P <.0001) and lymph node (22.4% vs 11.0%, P <.0001) recurrence rates were significantly higher in the BDSR group. Relapse-free survival (25.0 vs 34.0 months, P =.0184) and overall survival (41.2 vs 60.1 months, P =.0019) were significantly longer in the PD group. The PD group had significantly better prognosis in stage IA/IB cases (58.3 vs 111.5 months, P =.0067), which were the best indicators for BDSR, even when R0 resection was achieved. In multivariate analysis, BDSR was an independent poor prognostic factor. Conclusion: Despite the inferior perioperative short-term outcomes, our data advocate that PD should be the standard procedure for mid-BDCs and that BDSR should be avoided even if R0 resection can be achieved. (UMIN000017914).
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U2 - 10.1002/jhbp.724
DO - 10.1002/jhbp.724
M3 - Article
C2 - 32048467
AN - SCOPUS:85081318999
VL - 27
SP - 289
EP - 298
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
SN - 1868-6974
IS - 6
ER -