Surgical strategies for carcinoma of the hepatic duct confluence

Background This study was conducted to clarify the clinicopathological factors influencing appropriate surgical strategy and survival in patients with carcinoma of the hepatic duct confluence. Methods A total of 66 patients who underwent local resection of the bile duct with ( n = 44) and without ( n = 22) hepatectomy were reviewed retrospectively. Results Fifteen of the 44 patients who had hepatectomy and two of the 22 who did not suffered major postoperative complications ( P< 0·05). As the pT category rose, the incidence of microscopic tumour extension increased significantly. Invasion at the surgical margins was more frequent in the patients who did not have hepatectomy than in those who did. Extramural tumour extension was found in 23 of 28 patients, and its prevalence was higher in the hepatic direction than the duodenal direction. Cancer invasion to the caudate lobe was found in nine of 21 patients. Thirty of 44 patients who underwent hepatectomy had a curative resection compared with six of 22 who did not have hepatectomy ( P< 0·01). The cumulative survival rates after curative resection were significantly higher than after non‐curative resection ( P< 0·01). Conclusion Hepatectomy with caudate lobectomy improves the curability and prognosis because these tumours frequently invade the surgical margins. However, operative morbidity is higher with this procedure. © 1998 British Journal of Surgery Society Ltd