Background/aims: Since proximal-to-mid bile duct (BD) cancers often involve the proximal portion of the intrapancreatic BD, resection of the extrahepatic BD can result in a tumor-positive distal resection margin. It is essential that a surgical procedure is developed to obtain a tumor-free distal BD resection margin during extrahepatic BD resection, in which R0 resection can be achieved without performing pancreatoduodenectomy.
Methods: Based on preparatory clinicopathological analyses, excavation of the proximal intrapancreatic BD was designed to resemble a 2- to 3-cm-long funnel. The surgical procedure was a combination of the usual extrahepatic BD resection and funnel-shaped excavation of the proximal intrapancreatic BD.
Results: This unique procedure, called extended extrahepatic BD resection, was performed on 3 patients aged over 70 years with mid BD cancer. Deep intrapancreatic BD excavation per se required about 1 h. A tumor-free intrapancreatic BD resection margin was obtained in all 3 patients. Only minor complications occurred. Two patients are doing well without recurrence, at 20 and 14 months, respectively, and one is alive at 12 months with lymph node metastasis detected 1 month earlier.
Conclusion: By achieving R0 resection, this extended extrahepatic BD resection seems to benefit some proximal-to-mid BD cancer patients in whom pancreatoduodenectomy has a high operative risk.