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. 2023 Aug;53(8):899-906.
doi: 10.1007/s00595-022-02634-0. Epub 2022 Dec 23.

Vascular resection for distal cholangiocarcinoma

Ryusei Yamamoto  1 , Teiichi Sugiura  2 , Ryo Ashida  1 , Katsuhisa Ohgi  1 , Mihoko Yamada  1 , Shimpei Otsuka  1 , Takeshi Aramaki  3 , Koiku Asakura  3 , Katsuhiko Uesaka  1
Affiliations

Vascular resection for distal cholangiocarcinoma

Ryusei Yamamoto et al. Surg Today. 2023 Aug.

Abstract

Purpose: Vascular resection (VR) is extended surgery to attain a negative radial margin (RM) for distal cholangiocarcinoma (DCC). The present study explored the significance of VR for DCC, focusing on VR, RM, and findings suggestive of vascular invasion on multidetector-row computed tomography (MDCT).

Methods: Patients with DCC who underwent resection between 2002 and 2019 were reviewed.

Results: Among 230 patients, 25 received VR. The overall survival (OS) in the VR group was significantly worse than in the non-VR group (16.7% vs. 50.7% at 5 years, P < 0.001). Patients who underwent VR with a negative RM failed to show a better OS than those who did not undergo VR with a positive RM (19.7% vs. 35.7% at 5 years, P = 0.178). Of the 30 patients who were suspected of having vascular invasion on MDCT, 11 did not receive VR because the vessels were freed from the tumor; these patients had a significantly better OS (57.9% at 5 years) than those who underwent VR.

Conclusions: VR for DCC was associated with a poor prognosis, even if a negative RM was obtained. VR is not necessary for DCC when the vessels are detachable from the tumor.

Keywords: Bile duct neoplasm; Hepatic artery; Margins of excision; Pancreatoduodenectomy; Portal vein.

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