Malignant tumours of the bile-ducts

Abstract

SUMMARYThe 77 cases of malignant neoplasm of the extrahepatic bile-ducts treated at the Lahey Clinic between 1965 and 1969 are reviewed. Exploratory laparotomy was performed in 68 cases, although in 9 cases operation was not indicated because of the patients' poor condition. Of the 68 surgical patients, 24 (35 per cent) had a radical procedure, of which 17 survived for more than I year and 5 are still alive more than 3 years later, 3 having no evidence of recurrent disease. Forty-one patients had palliative treatment usually with some form of decompression procedure of the obstructed common bile-duct, and in 15 patients this was combined with hepatic artery infusion chemotherapy. Of these patients, 16 survived for more than I year, including 9 from the group treated by hepatic artery infusion chemotherapy. Only I patient is still alive after more than 3 years.Of all the patients, 44 per cent survived for more than I year, 23 per cent for more than 2 years, and 8 per cent for more than 3 years. The mean survival time was 13 months. These results compare favourably with those of the previous survey from the Lahey Clinic, and it is concluded that the improvement is the result of the increase in the radical resection rate from 18 to 31 per cent and in the institution of hepatic artery infusion chemotherapy in palliative cases.MALIGNANT tumours of the bile-ducts have been associated with a very poor prognosis despite the fact that the majority of these tumours tend to be slow growing without widespread metastases. This is mainly because of the difficulty of early diagnosis * Present address : Westminster Hospital, London. t Present address : Liverpool Royal Infirmary, Liverpool. 36and the proximity of these tumours to vital structures. Braasch, Warren, and Kune (1967) reviewed the total experience of the Lahey Clinic in treating neoplasms of the bile-ducts from 1920 to 1965 and reported 173 cases. Only 25 patients (14 per cent) were known to have survived I year or more and only 7 for more than 3 years.During the past 5 years an attempt has been made whenever possible to be more radical in the surgical management of this condition as suggested by Quattlebaum and Quattlebaum (1965). Hepatic artery infusion chemotherapy was first performed for non-resectable lesions in 1965. We have therefore reviewed the records of patients treated from 1965 to 1969 to determine whether this more radical surgical approach together with infusion chemotherapy for the non-resectable lesions has resulted in a better prognosis. RESULTSBetween 1965 and 1969 77 patients (44 men and 33 women) with primary malignant neoplasms of the bile-ducts were treated at the Lahey Clinic Foundation. T h e youngest patient was 31 years, the oldest 79 years, and the average age was 57 years. The peak incidence was in the sixth decade (Fig. I).The site of origin of the neoplasms is shown in Fig. 2. The commonest site was found to be the common hepatic duct (28 cases), followed by the retroduodenal portion of the bile-duct (18 cases) and the supraduodenal port...

High bile duct strictures

“…The ideal surgical treatment-excision of the neoplasm-is rarely feasible (30). Moreover, with lesions high in the porta hepatis, there is rarely sufficient ductal tissue proximal to the neoplasm to permit conventional bypass ( 15,16,(31)(32)(33)(34)(35)(36)(37).…”

Direct cholangiography

“…Like central lesions, the more common (60%) peripheral bile duct cancers are demonstrated in direct cholangiography as nonspecific stenoses or obstructions (Longmire et al, 1973;Ohto et al, 1980;Tompkins et al, 1981;Warren et al, 1972). They may also present with bilevel obstruction as a result of central lymphadenopathy.…”

Annual review of surgery 1972

“…Warren, Mountain & Lloyd-Jones (1972), from the Lahey Clinic, have reviewed seventy-seven cases of malignant tumour of the bile ducts and found that radical surgery was possible in twenty-four of these, in which seventeen survived for more than a year, and five are still alive over 3 years later. Surgery comprised either pancreaticoduodenectomy, or resection with -end-to-end anastomosis.…”