Surgical treatment of carcinoma of the hepatic duct confluence: Analysis of 55 resected carcinomas

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Abstract
We treated 65 patients with carcinoma of the hepatic duct confluence between 1976 and 1991, 57 (87.7%) of whom were treated surgically; of the 57, 55 (96.5%) underwent resection. Radical resection was performed at a rate of 50.9%. Procedures for these 55 patients included resection of the extrahepatic bile duct plus hepatectomy (n=33; 60.0%), and resection of the duct without hepatectomy (n=22; 40.0%). In addition, the caudate lobe was resected in 28 of these patients, and the portal vein, hepatic artery, or both were resected in 6. The overall operative morbidity was 21.8%; morbidity occurred in 33.3% of patients with hepatectomy, a significantly higher percent than the 4.5% rate in those without hepatectomy (pp<0.05). Furthermore, cumulative survival rates were higher for hepatectomy patients with resection of the caudate lobe than for those without resection of the caudate lobe. The results indicate that hepatectomy improves prognosis because cancer frequently invades the surgical margins in these tumors, although postoperative morbidity is higher with this procedure. Hence for poor‐risk patients (e.g., the elderly, those with poor hepatic functional reserve), caudate lobectomy with or without hilar hepatectomy may be the procedure of choice.