Carcinoma of the extrahepatic bile ducts

Fifty-two patients with carcinoma of the extrahepatic bile ducts were reviewed. There were 28 men and 24 women whose ages ranged from 31 to 78 years, with a mean age of 58 years. Symptoms, signs and laboratory results were primarily the result of bile duct obstruction. The most valuable diagnostic procedures were percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography. In 28 patients the tumor was located in the upper, 9 in the middle and 12 in the lower common bile duct. In the other three patients the tumor was diffuse. The resectability rate was 21.2% (11/52). Of the remaining patients, 10 (19.2%) had T-tube drainage, 5 (9.6%) had biliary digestive anastomosis, 18 (34.6%) had percutaneous transhepatic biliary drainage and 8 (15.4%) had biopsy only. The histologic diagnosis was sclerosing in 34 patients and papillary adenocarcinoma in 4 patients (10.5%). The incidence of associated gallstones was 21.2% (11/52). The overall hospital mortality was 23.1% (12/52), with none (0/11) for the resection group, 15.2% (5/33) for the drainage group and 87.5% (7/8) for the biopsy only group. The average survival time was 20.8 (10-48) months after resection; this was definitely better than 9.9 (4-30) months after drainage, and only one month after biopsy. The quality of life was much improved after resection compared to drainage. All these findings suggest that complete resection of the tumor or even life-saving drainage is worthwhile for carcinomas of the extrahepatic bile ducts.