Background: Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to improve survival. However, the wider the range of surgery, the higher the chance of complications; this, in turn, makes adjuvant treatment impossible. Nevertheless, no definitive surgical strategy considers the possible complication rates and subsequent adjuvant treatment. We aimed to investigate the appropriate surgical type considering the margin status, complications, and adjuvant treatment in MBD cancer. Materials and Methods: From 2008 to 2017, 520 patients diagnosed with MBD cancer at the Samsung Medical Center were analyzed retrospectively according to the operation type, margin status, complications, and adjuvant treatment. The R1 group was defined as having a carcinoma margin. Results: The 5-year survival rate for patients who underwent R0 and R1 resection was 54.4% and 33.3%, respectively (p =0.131). Prognostic factors affecting the overall survival were the age, preoperative CA19-9 level, T stage, and N stage, but not the operation type, margin status, complications, or adjuvant treatment. The complication rates were 11.5% and 29.8% in the BDR and PD groups, respectively (p< 0.001). We observed no significant difference in the adjuvant treatment ratio according to complications (p= 0.675). Patients with PD who underwent R0 resection and could not undergo chemotherapy because of complications reported better survival rates than those with BDR who underwent R1 resection after adjuvant treatment (p= 0.003). Conclusion: The survival outcome of patients with R1 margins who underwent BDR did not match those with R0 margins after PD, even after adjuvant treatment. Due to improvements in surgical techniques and the ability to resolve complications, surgical complications exert a marginal effect on survival. Therefore, surgeons should secure R0 margins to achieve the best survival outcomes.
背景：切缘状态是中段胆管癌根治性手术后最重要的预后因素之一。为达到R0切除，胆管切除术常转为胰十二指肠切除术。此外，术后积极进行辅助治疗以提高生存率。然而，手术范围越广，并发症发生几率越高；这反过来又使得辅助治疗无法进行。尽管如此，目前尚无明确的手术策略考虑到可能的并发症发生率及后续辅助治疗。本研究旨在探讨中段胆管癌手术中，综合考虑切缘状态、并发症及辅助治疗的适宜手术方式。 材料与方法：回顾性分析2008年至2017年三星医疗中心诊断为中段胆管癌的520例患者，根据手术方式、切缘状态、并发症及辅助治疗进行分析。R1组定义为切缘癌残留。 结果：接受R0和R1切除患者的5年生存率分别为54.4%和33.3%（p=0.131）。影响总生存期的预后因素包括年龄、术前CA19-9水平、T分期和N分期，而与手术方式、切缘状态、并发症或辅助治疗无关。BDR组和PD组的并发症发生率分别为11.5%和29.8%（p<0.001）。根据并发症情况，辅助治疗比例无显著差异（p=0.675）。接受PD手术实现R0切除但因并发症未能化疗的患者，其生存率优于接受BDR手术实现R1切除并接受辅助治疗的患者（p=0.003）。 结论：即使接受辅助治疗，接受BDR手术的R1切缘患者的生存结果仍不及接受PD手术的R0切缘患者。由于手术技术的进步和并发症处理能力的提升，手术并发症对生存的影响有限。因此，外科医生应确保R0切缘以获得最佳生存结果。
肿瘤(癌症)患者之家