AbstractBackground and ObjectivesThe objective of this study was to analyze the survival outcome and the clinicopathological factors that influence survival and recurrence of middle and distal bile duct cancer after surgical resection.MethodsFrom January 2000 to June 2007, 125 patients underwent surgical resection for middle and distal bile duct cancer. The clinicopathological characteristics and survival outcomes were reviewed retrospectively.ResultsOf the 125 patients, 31 patients underwent segmental resection of the bile duct, and 94 patients underwent pancreaticoduodenectomy (PD). Overall survival rates were 85.8% at 1 year and 38.3% at 5 years. Lymph node metastasis, noncurative resection, poorly differentiated tumor, and preoperative bilirubin level greater than 5.0 mg/dl were significant independent predictors of poor prognosis by multivariate analysis. The number of metastatic lymph nodes did not significantly affect survival. Recurrence occurred in 72 patients (61.0%). Disease‐free survival rates were 74.1% at 1 year and 42.0% at 3 years. Lymph node and distant metastases and poorly differentiated tumors were found to be significant independent predictors of recurrence by multivariate analysis.ConclusionsR0 resection confers a survival benefit, thus the surgeon should make an effort to achieve R0 resection. The presence of lymph node metastasis was a significant prognostic factor. J. Surg. Oncol. 2009;99:335–342. © 2009 Wiley‐Liss, Inc.