Safety and long-term outcomes of extrahepatic bile duct resection for early stage extrahepatic cholangiocarcinoma: Comparison with pancreaticoduodenectomy.

Abstract

Extrahepatic bile duct resection has been proposed as a less invasive alternative to pancreaticoduodenectomy for selected patients with extrahepatic cholangiocarcinoma. However, its oncological validity in early stage disease remains unclear. This study compared short- and long-term outcomes of extrahepatic bile duct resection and pancreaticoduodenectomy in early stage extrahepatic cholangiocarcinoma. Patients who underwent extrahepatic bile duct resection or pancreaticoduodenectomy between 2009 and 2024 were retrospectively reviewed. Patients with distant metastasis or preoperative chemotherapy were excluded. Clinicopathologic characteristics, postoperative outcomes, recurrence-free survival, and overall survival were compared in patients with early stage disease (Tis-T2 and N0). Survival analyses were performed using Kaplan-Meier and Cox proportional hazards models. Of 109 patients (extrahepatic bile duct resection, n = 34; pancreaticoduodenectomy, n = 75), extrahepatic bile duct resection was associated with a lower incidence of major complications (5.9% vs 45.3%, P < .01) and shorter hospitalization (11 vs 25 days, P < .01). However, extrahepatic bile duct resection was associated with significantly worse 5-year overall survival (38.9% vs 60.4%) and recurrence-free survival (31.7% vs 57.4%) compared with pancreaticoduodenectomy (both P < .01). Multivariate analysis identified extrahepatic bile duct resection and T2 stage as independent predictors of poor overall survival and recurrence-free survival. In patients with negative margin, extrahepatic bile duct resection was associated with worse 5-year overall survival (51.2% vs 61.6%, P = .051) and recurrence-free survival (37.3% vs 59.9%, P = .022) and higher local recurrence (38.1% vs 11.6%, P < .01). Despite lower perioperative morbidity, extrahepatic bile duct resection was associated with inferior oncological outcomes compared with pancreaticoduodenectomy, even in early stage extrahepatic cholangiocarcinoma. Pancreaticoduodenectomy should be considered the standard surgical procedure whenever feasible. Although extrahepatic bile duct resection should not be regarded as oncologically equivalent to pancreaticoduodenectomy, it may remain a treatment option for carefully selected patients who are unable to tolerate pancreaticoduodenectomy.