Influence of Cancer Cell Infiltration at Resection Margin of Hepatic Duct on Prognosis and Treatment of Middle and Lower Bile Duct Carcinoma

Whether or not a microscopically tumor-positive resection margin of the hepatic duct (hw (+)) affects the postresectional long-term prognosis was studied in 28 cases of middle and lower bile d uct cancer resected during the past 15 years (1978-1993). hw (+) was identified in 10 cases, or 36% of all cases. The pathological background was not different between hw (+) cases and those with a tumor-negative resection margin (hw (+)) except in d-factor. The five year survival rates of 30% in hw (+) and 43.8% inh w (+) were not significantly different. Intraoperative frozen section in 10 hw (+) cases was positive in 6, and negative in 4. Long-term survivors of more than 5 years numbered 6 in this series, and included 3h w (+) patients. Recurrence in long-term survivors, irrespective of hw positive or negative status, was characterized by anastomotic recurrence, while short-term survivors died exclusively of distant metastasesand peritonitis carcinomatosa. These results indicated that hw (+) is not a prognostic factor for the treatment of bile duct cancer. Since recurrence in short-term survivors seems not to be infl uenced byh w (+) as well, radical operation should be balanced with progression of the disease and curativity of the operation.