Surgical resection for carcinoma of the porta hepatis and proximal bile duct(including Klatskin tumor, gallbladder carcinoma and hepatoma which invased to proximal bile duct) has been a challenging problem. It was destined that the 50year
survival
rate
was less than 5 percents. The early diagnosis was difficult and the cases of surgical indications were rare.
The pathologic problems of bile duct carcinoma were ①tumor spreading along the submucosal or subserosal layer of the bile duct, ②infiltration of surrounding structures such as hepatic artery and portal vein, ③increased adjuvant tissue
invasion,
④infiltrating longitudinal and horizontal direction along the lymphatics and perineural space in hepatoduodenal ligament. Because of above problems, the operation results and survival rate were poor.
In proximal bile duct carcinoma and carcinoma of porta hepatis, the surgeons were tend to employing treatment of palliative intrahepatic decompressive procedure. But they were ineffective in increasing survival rate.
In this article, hepatectomy and the procedures which had been able to bypass drainage after septotomy on dissection of the branches of intrahepatic bile ducts, had have been seen high curative resectability and rare post-op complications and
high
survival rates.
We believed that these more radical approaches(12 cases), that were wide tumor resection including liver resection and bypass drainage with internal stent after septotomy to the best possibility of prolonged survival, the best quality of life and
even
cure for suitable patients with carcinoma of the porta hepatis and proximal bile duct.
The mean survival months was 28 months and the survival rate was 0.62 during 46 months with Kaplan-Meier product limit probability.
|