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Invited Commentary

Andrew L Warshaw, MD
Arch Surg. 1993;128(8):879. doi:10.1001/archsurg.1993.01420200053009.
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This study reconfirms that resection of cholangiocarcinoma at any position along the biliary tract is feasible and can be accomplished with acceptable safety and that cures are possible. The authors state that this experience has converted them from their previous position of skepticism and, perhaps, fatalism to one of belief in removing the tumor, if possible, as the only avenue to possible salvation. This is not a new concept. Many recent studies, especially from Japan, have emphasized aggressive resection. As in those other experiences, the Mayo group found that the majority of proximal cholangiocarcinomas (eight of 13) required hemihepatectomy for extirpation. They also reconfirmed that valid independent determinants of survival include resection margins clear of tumor, tumor grade, ECOG performance status, and preoperative bilirubin peak concentration. What is surprising is that the 5-year survival rate was equivalent for proximal (hilar) cancers and distal cholangiocarcinomas, 43% and 46%, respectively. Nonetheless, all


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