Prolongation of survival for carcinoma at the hepatic duct confluence.

Because of poor long-term results in resection for carcinoma at the hepatic duct confluence, we have adopted a more aggressive approach. The records of 46 patients with carcinoma of the hepatic duct confluence were reviewed. Twenty-four patients underwent hepatic resection and 10 underwent local resection. The remaining 12 patients had unresectable lesions and received palliative treatment. Out of 24 patients who underwent hepatic resection, 17 underwent combined resection of the caudate lobe. Five patients who underwent hepatic resection and three patients who underwent local resection received intraoperative radiotherapy in a dose of 30 Gy of electron beam. Postoperative radiotherapy with a total dose of 50 Gy of external electron beam was performed for five patients who underwent nonradical hepatic resection and one patient who underwent nonradical local resection. None of the 10 patients who underwent local resection and only 1 (4.2%) of 24 patients who underwent hepatic resection died in the hospital. Among patients who underwent hepatic resection, the 1-, 3-, and 5-year survival rates were 62%, 37%, and 25%, respectively, whereas the respective survival rates in the group that underwent local resection were 50%, 20%, and 20%. The 1-, 3-, and 5-year survival rates for patients who underwent combined caudate lobectomy were 69.7%, 53.4%, and 23%, respectively, compared with 57.1%, 26%, and 14.3% for those who did not. The median survival time for patients who received radiotherapy after nonradical resection was 17 months, compared with 5 months for those who did not. These results suggest that major hepatic resection combined with caudate lobectomy should be performed for carcinoma of the heptic duct confluence. Postoperative radiotherapy after nonradical resection may be effective in prolonging survival.