Abstract
Curative resection was accomplished in 28 of 82 patients with biopsy-proven carcinoma of the extra-bepstic bile ducts, gallbladder, and ampulla of Vater seen initially at the Massachusetts General Hospital from 1962 through 1978. None of the 28 had adjuvant radiation therapy nor chemotherapy. Later evidence of cancer (failure) was found in 16 of 25 patients who were post-op survivors. Local-regional recurrence ± distant metastases (documented at re-exploration, autopsy, or clinically) occurred in 13 16 , and only 3 developed distant disease only. Local-regional failure rates varied with anatomic location: 4 10 ampulla of Vater, 7 11 gallbladder, 1 3 common bile duct, land 1 1 hepatic duct (“Klatskin”) The time to local-regional recurrence ranged from 2 to 100 months post-operatively with a median of 17 months. Only 5 patients of the 28 are presently alive NED. The prognostic significance of tumor grade, lymph node involvement, perineural-lymphatic-venous invasion, and extension through the waq relative to patterns of failure are presented, and the implications for adjuvant therapy are discussed.
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