[The study for the surgical treatment on distal bile duct carcinoma]

The surgical result in 74 patients with resected distal bile duct carcinoma was reviewed to clarify the surgical strategy of distal bile duct carcinoma. The clinicopathological record was according to the General rules for surgical and pathological studies on cancer of biliary tract(the 3rd edition, edited by the Japanese society of biliary surgery). 58 patients underwent standard pancreatoduodenectomy and 16 patients had pylorus-preserving pancreatoduodenectomy. The curative resection was performed in 38 patients (51.3%). The overall 5-year survival rate (operated death included) was 35.8%. The 5-year survival rate in curative resection was 56.6%. The survival rate of patients with curative resection was significantly better than that of the patients with relative non-curative (p < 0.05) or absolute non-curative resection (p < 0.01). We concluded that the Long-term survival after surgical resection was mostly correlated with curability. To obtain curative resection, the free surgical margin of hw and ew was essential. As for free "hw", intraoperative frozen dissection was indispensable. For free "ew", the dissection of the soft tissues in retroperitoneum at the back of pancreas head was necessary. On the lymph node dissection, the lymph nodes of No 8, 12, 13, 14 should be removed.