Surgical strategy for bile duct cancer: Advances and current limitations

Table 1 Review of the literature on pancreaticoduodenectomy for distal bile duct cancer

Author	Yr	Resections (n)	R0 resection (%)	Overall 3-yr survival (%)	Overall 5-yr survival (%)	R0 5-yr survival (%)	Operative mortality (%)
Kayahara et al[119]	1999	50	72	47	35	48	2
Suzuki et al[120]	2000	99	52	50	37	52	3
Yeo et al[21]	2002	49	NA	38	16	NA	33
Yoshida et al[121]	2002	27	85	37	37	44	4
Sakamoto et al[122]	2005	55	84	52	26	NA	7
Jang et al[123]	2005	103	84	38	30	NA	5
Cheng et al[124]	2007	112	87	51	25	27	3
Murakami et al[125]	2007	36	81	54	50	62	0
Sasaki et al[126]	2007	77	92	NA	37	362	NA
DeOliveria et al[127]1	2007	239	78	35	23	27	3
Allen et al[128]	2008	98	85	45	43	422	3
Bahra et al[129]	2008	95	81	36	29	34	4
Lee et al[116]	2009	149	NA	46	38	NA	NA
Hong et al[33]	2009	147	90	33	18	NA	NA
Nomura et al[130]	2009	57	61	NA	36	NA	2
Kawai et al[131]	2010	62	77	63	52	59	0

¹Including palliative operations;

²Including hilar cholangiocarcinoma;

³Including operations for pancreatic cancer. NA: Not available; R0: Negative surgical margin.

Table 2 Review of the literature on hepatectomy for hilar bile duct cancer

Author	Yr	Resections (n)	Major hepatectomy (%)	R0 resection (%)	Overall 3-yr survival (%)	Overall 5-yr survival (%)	R0 5-yr survival (%)	Operative mortality (%)
Neuhaus et al[26]	1999	80	85	61	NA	22	37	8
Todoroki et al[142]	2000	101	58	14	NA	28	38	4
Lee et al[73]	2000	111	99	78	52	22	NA	6
Nimura et al[71]	2000	142	90	61	43	26	27	9
Capussotti et al[146]	2002	36	83	89	41	27	29	3
Seyama et al[147]	2003	87	67	64	55	40	46	0
Kawasaki et al[135]	2003	79	87	68	NA	22	40	1
Rea et al[148]	2004	46	100	80	39	26	30	9
Hemming et al[149]	2005	53	98	80	60	35	45	9
Dinant et al[150]	2006	99	38	31	37	27	33	15
Sano et al[151]	2007	126	100	56	44	35	NA	4
Baton et al[152]	2007	59	100	46	45	20	22	5
Hasegawa et al[153]	2007	49	90	78	50	40	50	2
Allen et al[128]	2008	106	82	77	45	29	421	4
Ito et al[45]	2008	38	53	63	65	33	60	0
Hirano et al[154]	2009	146	90	90	53	36	NA	3
Lee et al[155]	2009	302	89	71	41	33	47	2
Young et al[156]	2009	51	92	57	36	20	40	8
Igami et al[157]	2009	298	98	74	49	42	52	2
Miyazaki et al[158]	2009	107	91	59	45	28	33	2
Unno et al[159]	2009	125	100	63	37	35	46	8
Murakami et al[160]	2009	42	86	74	42	30	NA	7

¹Including distal bile duct cancer. NA: Not available; R0: Negative surgical margin.

Table 3 Review of the literature on adjuvant therapy for surgically resected bile duct cancer

Author	Yr	Background			P-value	Comments
Chemotherapy			Without chemotherapy	With chemotherapy
Takada et al[186]	2002	Curative-resection	28% 5-yr OS	41% 5-yr OS	0.48	Two courses of mitomycin C plus infusional 5-FU, followed by oral 5-FU until tumor progression; 40% received a non-curative operation
		Non-curative resection	16% 5-yr OS	8% 5-yr OS	0.300
Yubin et al[187]	2008	Hilar cholangiocarcinoma	37 mo MS	43 mo MS	< 0.05	Infusional gemcitabine based; no discrimination between curative and palliative resection; some of patients received radiation but the contribution of radiation was not analyzed
Murakami et al[160]	2009	Hilar cholangiocarcinoma	23% 5-yr OS	57% 5-yr OS	0.026	Infusional gemcitabine and oral S-1, every 2 wk
Radiation			Without radiation	With radiation
Pitt et al[188]	1995	Hilar cholangiocarcinoma	20 mo MS	20 mo MS	NS
Cameron et al[189]	1990	Hilar cholangiocarcinoma	21% 3-yr OS	21% 3-yr OS	NS
Zlotecki et al[190]	1998	Bile duct cancer	19% 5-yr OS	35% 5-yr OS	NS
Heron et al[195]	2003	Distal cholangiocarcinoma	63 mo MS	MS not reached (> 129 mo)	NS
Gonzalez et al[194]	1999	Hilar cholangiocarcinoma Hilar cholangiocarcinoma			0.023
			8 mo MS	19 mo MS	0.001
Schoenthaler et al[193]	1994	R1 resection	11 mo MS	22 mo MS, X-rays	0.010
				61 mo MS, charged particles	0.001
Cheng et al[192]	2007	Hilar cholangiocarcinoma	HR 4.3, 95% CI 3.6-4.9		< 0.01	Radiation was significantly helpful for R1/2 resection patients
Todoroki et al[191]	2000	Bile duct cancer	14% 5-yr OS	34% 5-yr OS	0.010	Radiation was significantly helpful for R1 resection patients
Gerhards et al[197]	2003	Hilar cholangiocarcinoma	8 mo MS	24 mo MS	< 0.05
Chemoradiation			Without chemoradiation	With chemoradiation
Nakeeb et al[198]	2002	Bile duct cancer	11 mo MS (Chemotherapy alone)	16 mo OS	0.020	Chemotherapy; 5-FU
			8 mo MS (Radiation alone)
Kim et al[199]	2002	Bile duct cancer	9% 5-yr OS (Radiation alone)	41% 5-yr OS	0.0005	Chemotherapy; 5-FU, P = 0.14 in multivariate analysis
Serafini et al[200]	2001	Bile duct cancer	29 mo MS (Surgery alone)	42 mo MS	0.07	Chemotherapy; 5-FU; when stratified by location, only distal tumors significantly benefited (41 mo MS vs 25 mo MS, P < 0.05)
Hughes et al[201]	2007	Distal cholangiocarcinoma	22 mo MS (Surgery alone)	37 mo MS	0.04	Chemotherapy; 5-FU

MS: Mean survival; NS: Not significant; OS: Overall survival; R1: Microscopically positive margin; R2: Macroscopically positive margin; HR: Hazard ratio; CI: Confidential interval.