Surgical strategies for XXXX of the hepatic duct confluence.

@entity1 @entity5 @entity189 @entity260
BACKGROUND: This study was conducted to clarify the clinicopathological factors influencing appropriate surgical strategy and survival in @entity1 with @entity189 of the hepatic duct confluence. METHODS: A total of 66 @entity1 who underwent local resection of the bile duct with (n = 44) and without (n = 22) hepatectomy were reviewed retrospectively. RESULTS: Fifteen of the 44 @entity1 who had hepatectomy and two of the 22 who did not suffered major @entity260 (P < 0.05). As the pT category rose, the incidence of microscopic @entity5 extension increased significantly. Invasion at the surgical margins was more frequent in the @entity1 who did not have hepatectomy than in those who did. Extramural @entity5 extension was found in 23 of 28 @entity1 , and its prevalence was higher in the hepatic direction than the duodenal direction. Cancer invasion to the caudate lobe was found in nine of 21 @entity1 . Thirty of 44 @entity1 who underwent hepatectomy had a curative resection compared with six of 22 who did not have hepatectomy (P < 0.01). The cumulative survival rates after curative resection were significantly higher than after non-curative resection (P < 0.01). CONCLUSION: Hepatectomy with caudate lobectomy improves the curability and prognosis because these @entity5 frequently invade the surgical margins. However, operative morbidity is higher with this procedure.
