Surgical treatment for proximal bile duct carcinoma.

BACKGROUND

The surgical management of proximal bile duct carcinoma is controversial. There is no consensus among surgeons as to the indications for radical resection. This article described personal experience with the different surgical procedures for patients with proximal bile duct carcinoma.

METHODS

The medical records of fifty-two consecutive patients undergoing surgical resection over a 20-year period were retrospectively analysed in terms of pathology, perioperative mortality, clinical course, and overall survival.

RESULTS

The 1-, 3- and 5-year survivals for the entire group were 63.3%, 24.5%, and 21.0%, respectively. The results for local resection of the extrahepatic bile duct in 35 cases were unsatisfactory. Radical resection that included the right extended hepatic lobe, caudate lobe, and extrahepatic bile duct was performed in 9 patients and demonstrated an excellent 5 year survival rate of 44.4%. However, hospital mortality was 22.2%. There was no significant difference among the operative procedures for patients with advanced disease.

CONCLUSION

Radical resection remains the procedure of choice in proximal bile duct carcinoma. However, results with surgical therapy alone remain unsatisfactory. Multimodality treatment that also includes radiotherapy and/or chemotherapy is recommended.