Twenty-three patients with primary adenocarcinoma arising from the extrahepatic bile ducts, exclusive of gallbladder and ampulla of Vater, were seen at Inje Medical College Paik Hos-pital, Seoul, between 1973 and 1983.
Extrahepatic bileduct cancer was seen exclusively in older age group, especially between 50~60 years of age, and was slightly more frequent in man. The chief complaints were jaundice, itching, abdominal pain, indigestion, weight loss, etc. The most accurate diagnostic study proved to be PTC.
Curative resection was possible in 4 patients (17%) with no operative mortality. Three patients who were subjected to Whipple operation for lower and middle ductal cancers have lived for 5 years and 3 months, 5years, and 7 months respectively, and every one of them is still alive. The remaining one patient had undergone curative segmental resection of the duct with Roxu-en-Y hepaticojejunostomy for upper duct cancer but lived only for a period of 13 months.
Palliative biliary decompression was done in 14 patients with appreciable improvement in survival, the operative mortality being 28%(4/14). The most common reason for unrectability was cancerous infiltration of the hepatic artery, portal vein or liver, and metastases to panc-reas, hepatoduodenal or celiac lymph nodes, peritoneum or diaphragm.
The tumors in all 23 cases were adenocarcinomas. Papillary adenocarcinoma was associated with exceptionally good prognosis in this series. Both of them have lived for nearly 3 years and are still alive.
With Whipple procedure in selected cases of middle and lower ductal cancer, a long-term survival or possible cure is to be anticipated. For the unresectable tumors, improved survi-val could be expected with palliative drainage. However, early diagnosis with increment of resectablity is essential for the improvement of treatment results.
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