The experiences of hilar skeletonization for the treatment of locally advanced proximal bile duct cancer

Background/Aims: Because proximal bile duct cancer easily involves the surr ounding tissue, tumor cells often remain after apparent macroscopically com plete radical resection. We evaluated the effect of resective modality of t hese tumors on prognosis and the effect of postoperative radiotherapy on su rvival of patients with microscopic residual tumor following local resectio n in locally advanced proximal bile duct cancer. Methodology: From November, 1990 to October, 1993, 45 proximal bile duct ca ncer patients who received local excision were entered onto this prospectiv e, nonrandomized study. The patients were divided into three groups after o peration, 16 patients with curative resection; 15 noncurative resection; an d 14 nonresection. Patients who had positive lymph nodes or microscopic can cer cells in resection margin or adjacent major vessels, were treated with postoperative external radiotherapy, 5040 cGy for 40 days. Results: The overall 1-, 2-, and 5-year survival of the patients was 62.2%, 24.4%, and 15.6%, respectively. The overall mean and median survival of pa tients was 24.1 +/- 3.98 (mean SE) months and 13 +/- 0.74 months, respectiv ely. Survival rates between resection and nonresection showed a statistical ly significant difference (P < 0.05). However, survival rates between curat ive resection and noncurative resection with postoperative radiotherapy wer e not statistically significant (P > 0.05). Conclusions: The resection is the treatment of choice for locally advanced proximal bile duct cancer, if resectable and the noncurative resection foll owed by postoperative external radiotherapy may be beneficial to the patien ts with locally advanced proximal bile duct cancer.