Liver metastases after curative resection in patients with distal bile duct cancer

Background: Curative resection cannot ensure long-term survival for patient s with distal bile duct cancer. The aim of this study was to determine the most frequent mode of recurrence after curative resection and to analyse it s risk factors. Methods: Clinical details for 64 consecutive patients with distal bile duct cancer who underwent surgical resection between 1980 and 1997 were reviewe d. Modes of recurrence and clinicopathological findings were analysed based on the residual tumour (R) classification. Results: The overall actuarial 5-year survival rate was 32 per cent. Of 42 patients undergoing R-0 resection 10 were alive at 5 years, of 17 having R- 1 resection one was alive at 5 years, and none of the five patients having R-2 resection survived for 5 years (R-0 versus R-1, P = 0.02). In the R-0 g roup, the incidence of liver recurrence (14 of 42 patients) was similar to that in the R-1 resection group (six of 17), although there were fewer lymp h nude and peritoneal recurrences than in patients who had R-1 resection (P < 0.05). The high-risk factor for liver metastasis was microscopic vascula r involvement. Important factors for survival were lymph node metastasis, m icroscopic vascular involvement and age. In addition, microscopic vascular involvement was the only independent factor for survival in the R-0 group. Conclusion: R-0 resection provided significant survival benefit but bird no effect on liver recurrence. Therefore, new agents or strategies to prevent liver metastasis are necessary for improvement of survival.