Outcome of treatment for distal bile duct cancer

Abstract

All patients with distal bile duct tumours over a 10-year period (October 1983 to December 1993) were identified by means of a prospective database. The medical records of 104 patients were reviewed. Univariate and multivariate analysis for predictors of outcome was performed. Median age of the patients was 65 (range 30-89) years. Patients presented with a clinical picture indistinguishable from that of pancreatic ductal adenocarcinoma. Twenty patients had no surgical treatment and 23 had a diagnostic laparotomy only. Biliary bypass was performed in 16 patients and radical resection was performed in 45 (pancreaticoduodenectomy, 39; bile duct excision, six). Operative mortality occurred in two of 45 patients having radical resection and complications in 17. Resection provided significant survival benefit. By univariate and multivariate analysis, resectability and negative node status (P < 0.001) were the only predictors of favourable outcome. Sex, age, preoperative stenting, grade of tumour and bilirubin level did not predict outcome. The 5-year survival rate for radically resected, node-negative tumours was 54 per cent. Surgical resection is effective therapy for distal bile duct tumours. These patients have a better outlook than those having resection of pancreatic adenocarcinoma.

Carcinoma of the middle bile duct: Is bile duct segmentalresection appropriate?

“…PD or bile duct segmental resection (BDSR) is performed at the surgeon's discretion. Clinicopathological studies on hilar and distal cholangiocarcinomas have been done by many authors [2][3][4][5][6][7][8][9][10][11] , and the results of BDSR for MBD have been reported, but most of these studies involved a very limited number of cases, and the number of cases is not enough to justify BDSR as a standard treatment.…”

Superficial vs deep pancreatic parenchymal invasion in the extrahepatic bile duct carcinomas: a significant prognostic factor

“…[3][4][5][6][7][8][9] The only effective treatment for the distal EBD carcinomas is a complete surgical resection. 3,6,7 After complete resection of the distal EBD carcinomas, 5-year survival rate was reported to be 15-45%, while the median survival time of the patients having the palliative bypass surgery or biliary stent was reported to be less than 1 year. 3,6,7,[15][16][17][18] The patients with the EBD carcinomas are known to have a poor survival when pancreatic invasion is present.…”

“…3,6,7 After complete resection of the distal EBD carcinomas, 5-year survival rate was reported to be 15-45%, while the median survival time of the patients having the palliative bypass surgery or biliary stent was reported to be less than 1 year. 3,6,7,[15][16][17][18] The patients with the EBD carcinomas are known to have a poor survival when pancreatic invasion is present. 10,11 In the present study, we classified the distal EBD carcinomas according to the degree of the pancreatic invasion and compared the survival rate of each class.…”

“…6,16,[19][20][21] The dependency between the depth of invasion and the status of lymph node metastasis was not statistically significant (P ¼ 0.07). When lymph node metastasis was absent, group 2 demonstrated significantly worse survival than group 1 (Po0.001), while when lymph node metastasis was present, the difference was not statistically significant (P ¼ 0.17).…”

“…1,2 The EBD carcinomas originating from the lower to middle portions of the bile duct (distal EBD carcinoma) are composed of 20-30% of the entire EBD carcinomas. [3][4][5][6][7][8][9] The pancreatic invasion of the EBD carcinomas has been known to be a bad prognostic sign. 10,11 However, we experienced that several patients with the EBD carcinoma with superficial pancreatic invasion had a more favorable survival outcome than we expected.…”