Multidetector computed tomography for preoperative prediction of postsurgical prognosis of patients with extrahepatic biliary cancer

BACKGROUND: Preoperative prognostic information to select a treatment strategy is important especially in patients who need highly aggressive surgery, such as those with biliary cancer. We evaluated various prognostic factors and non-curative surgical factors using multidetector computed tomography (MDCT). METHODS: We retrospectively analyzed 71 patients who underwent MDCT preoperatively and were scheduled for surgical resection of biliary cancer. For MDCT diagnosis, we used MDCT-based classification equivalent to the surgical and pathological classification of the Japanese Society of Biliary Surgery. We evaluated MDCT-related prognostic factors and non-curative surgical factors and compared these factors with pathological results. RESULTS: MDCT-diagnosed category T (primary tumor invasion) included both prognostic factors and non-curative surgical factors but not category N (lymph node metastasis). Multivariate analysis identified MDCT-based suspected arterial invasion as an independent prognostic factor. In patients suspected of arterial invasion by MDCT, the 3-year overall survival rate was only 39% and the curative resection ratio was only 33%, because of the high positive surgical dissected margin. CONCLUSION: MDCT-based suspected arterial invasion is a predictor of poor prognosis after surgery for biliary cancer and represents a non-curative surgical factor associated with positive dissected margin.