Role of hepatectomy in the treatment of hilar bile duct carcinoma.

Purpose: To clarify the role of hepatic resection in the surgical treatment of hilar bile duct carcinoma.

Methods: Between 1980 and 1997, 68 patients underwent surgery for hilar bile duct carcinoma. The patients were divided into a hepatectomy group ( n = 40) and a nonhepatectomized group ( n = 28) depending on whether they underwent resection of the bile duct confluence in combination with hepatectomy, or alone, respectively. Background data, operative morbidity and mortality, and survival were retrospectively compared between the two groups.

Results: There were no significant differences in morbidity and mortality, or in postoperative survival between the two groups (the 5-year survival rates being 20.6% in the hepatectomized group and 7.1% in the nonhepatectomized group; P = 0.0806). However, patients who underwent curative resection had significantly better postoperative survival than those who underwent noncurative resection ( P = 0.048). Hepatectomy provided a significantly better cancer-free margin than bile duct resection alone ( P = 0.0296).

Conclusions: Although a countermeasure must be taken to decrease mortality, the introduction of hepatectomy with bile duct resection would provide a better cancer-free surgical margin than bile duct resection alone for hilar bile duct carcinoma. Curative resection contributed to long-term survival in this series.