J.Jpn. Surg. Soc.. 91(9): 1245-1248, 1990

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Report on the annual meeting

SIGNIFICANCE OF EXTENDED OPERATION FOR MIDDLE AND LOWER BILE DUCT CARCINOMA

Standard pancreaticoduodenectomy has been basically performed for middle and lower bile duct carcinoma. 5-year survival rate is 51.6% in stages 1 and 2, 15.3% in stages 3 and 4. These are not satisfiacfory. Furthermore, 3-year survival rate in noncurative resection for the cases of stages 3 and 4 is 14% which is extremely unsatisactory. The result of extended resection, following issues should be taken into consideration. To improve. 1) As to the “hw” factor, the resection line of the bile duct should be laid in the first bifurcation of intrahepatic duct for middle bile duct carcinoma, and just below the bifurcation of hepatic duct for lower bile duct carcinoma. 2) As to the “ew” factor, combined resection of portal vein should be performed aggressively for middle bile duct carcinoma, and the dissection of the nerve plexus including the soft tissue of retropeitoneum around the pancreas head region should be performed for the lower bile duct carcinoma. 3) As to the “n” factor, R2+14ab lymph nodes dissection should be performed for “so” cases, and R3 dissection should be performed for “ss”, “panc 2” and “panc 3” cases.

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