Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: A cooperative study of the Keio Bile Duct Cancer Study Group

Background. It is necessary to elucidate whether extensive resection of the bile ducts combined with liver resection is a feasible and valid procedure for cancer of the main hepatic duct junction. Methods. Based on a multiinstitutional study, resectability rate, operative mortality, long-term survival, and factors contributory to long-term survival were investigated. Results. Between January 1973 and December 1991, a total of 158 patients with this cancer were admitted to Keio University Hospital and six affiliated institutions. Eighty-three (53%) of the 158 patients underwent resection, with seven (8.4%) postoperative deaths. The operations were performed by seven surgeons who were in charge of liver surgery at each respective institution. The 5-year actuarial survival rate of the 83 patients who underwent resection was 20%. Twelve patients survived more than 5 years, and these patients underwent curative resection. Three of the 12 patients were doing well after 10 years. Procedures of liver resection were right trisegmentectomy in two patients and left lobectomy with resection of the right portal vein in one. Conclusions. It is clear that cancer of the main hepatic duct junction has become a curable disease. The operation is a valid procedure that can be widely practiced by competent surgeons.