Surgical treatment of hilar bile duct cancer: A critical review of 291 cases

Abstract

To summarize the clinical experience in the treatment of hilar bile duct carcinoma in a single institute through 1986–2002. 291 cases admitted to the General Hospital of P. L. A. were reviewed. The cases were divided into two groups: Group I, cases were admitted from 1986.1 to 1999.1, totally 157 cases; and Group II included cases which were treated from 1999.2 to 2002.6, totally 134 cases. The methods of surgical treatment included radical resection, palliative resection, external or internal drainage, according to the pathology found during surgery. Radical resection (free of residual tumor cells at the resection edge of the resected specimens) was 37.6% in group I and 41.2% in group II, respectively. There was no death within 30 days after resectional operation. Follow-up data was obtained through correspondence and outpatient department visits with the follow-up rate being 88.8%. Carcinoma of the proximal extrahepatic bile duct was not a rare disease in China and the number of operations on bile duct cancer was increased in recent years. Owing to the location of the tumor, radical resection was difficult to reach even supplemented by liver lobe resection. Radical resection rate was from 37.6% to 41.2% in these two series of cases studied. There were 4 cases of tumor-free survivals in the group I (13.3%), and furthermore, there were also 2 cases with tumor recurrence and still under treatment. In group II, there was no 5 year survivals and the 3-year survival rate was 13.6%. Carcinoma of the hilar bile duct is a disease of multiformity. Rarely, it may behave a rather benign course, but, in the majority, the disease was likely to be recurrent even after a seemingly radical resection. However, resectional treatment, even palliative, may prolong life and improve the quality of life. The value of extended resection and lymph nodes dissection operation is still uncertain.