XXXX involving the extrahepatic bile duct is worthy of resection.

@entity1 @entity1087 @entity190 @entity3121 @entity1086
OBJECTIVE: To clarify the value of resection of @entity1086 involving the extrahepatic bile duct. BACKGROUND: : Several recent studies have proven that @entity1087 and extrahepatic biliary involvement are independent predictors of a poor outcome. Only a few authors recommend resection of such advanced disease. METHODS: One hundred @entity1 with pT3/4, @entity3121 , M0 disease were the subjects of this study. Mortality and long-term outcome were analyzed using a prospectively collected database. RESULTS: The only factor associated with mortality in univariate and multivariate analyses was intraoperative @entity190 . The 5-year survival rate and median survival time were 23% and 1.5 years for @entity1 with pathologic extrahepatic biliary invasion (pEBI), and 54% and 15.4 years for @entity1 without pEBI. Twelve @entity1 with pEBI survived beyond 5 years. Multivariate analysis revealed that R1/2 resection and combined resection of adjacent organs other than the liver and extrahepatic bile duct (CRAO) were independent predictors of poor outcome. Five-year survival rate and median survival time after R0 resection without CRAO were 36% and 3.8 years even in @entity1 with pEBI. In contrast, after R0 resection with CRAO 5-year survival and median survival time were 16% and 0.8 years, respectively. CONCLUSIONS: @entity1 with advanced @entity1086 with pEBI are candidates for resection when distant metastases are absent and R0 resection is achievable. When CRAO is unnecessary, surgical resection should be aggressively planned.
