The management of extrahepatic bile duct carcinoma.

Abstract

A series of 63 patients with primary bile duct carcinomas seen at the UCLA Hospital since 1955 have been analyzed and divided into four groups, depending upon the site of the tumor in the extrahepatic ductal system. More than half of the tumors occurred in the upper one-third, while the other half was about equally divided between those occurring in the middle and lower thirds of the extrahepatic duct system. Three wide-spread intraluminal papillary tumors have been placed in a special category. The difficulties of establishing a correct diagnosis at the time of operation are again demonstrated in this series. The most commonly used palliative procedure has been the insertion of a tube into the duct that passes above and below the tumor through the site of obstruction. The tumors are generally small, well-localized, and frequently slow-growing. Tumors in the lower one-third of the duct may be treated by radical en bloc resection (pancreaticoduodenectomy) and offer the best prognosis, both for long-term palliation and cure. More than half of the tumors in this series were located at or near the confluence of the hepatic ducts, and resection of the tumor was attempted in only six of 34 cases. It is possible that, were procedures available that would permit a more extensive en bloc resection of tumors in the middle and upper thirds of the duct system, the period of palliation might be extended and more “cures” obtained. Detailed anatomical studies of the hepatic ducts, arteries, and portal veins at the hilus support the concept of combining extended hepatic resection with tumor excision and including segments of the hepatic blood supply in selected patients with tumors in the upper one-third of the duct. Operative procedures for resection of the right and left lobes have been proposed. One such operation has been performed; in a second patient, hepatic lobectomy and tumor excision were performed without interruption of the blood supply to the remaining lobe.