Extrahepatic bile duct cancer has been known as a frustrating and difficult lesion not only in diagnosis but also in management of it. It recent years, however, improved survival after an aggressive surgical resection of bile duct cancer was
reported.
This report presents the result of 32 extrahepatic bile duct cancers resected at the department of surgery, Masan Goryo General Hospital, from 1981 to 1991. All cases were possible to followup.
The most prevalent age group was 6th decade and mean age was 54.9 years and the sex ratio was 1.9:1 with male predominance.
The most common site of the cancer was upper one third of the bile duct (17 cases), followed by lower one third and diffuse type. Radical resection was performed in 21 patients and palliative resection in 11. For the lesion of upper one third,
bile
duct
resection and Roux-en-Y hepaticojejunostomy was performed in 16 of 17 patients. Pancreaticoduodenectomy was underwent for all the lesion of lower one third. In diffuse type, bile duct resection with Roux-en-Y hepaticojejunostomy was performed in
five
cases.
Overall complication rate was 40.6% (13/32) and the most common complication was leakage of the anastomosis and wound infection.
The operative mortality was 10.7%, two sepsis and one bleeding.
By TNM classification (AJCC, 1992), stage IVa (37.5%) was most common and stage II (34.4%) was next in order.
Among the 32 adenocarcinoma, ninetee cases were a well-differentiated lesion (59.4%) and eleven were moderately differentiated (34.4%).
Overall 1, 3, 5 year survival rate was 46.2%, 13.3% and 7.1% respectively. In radically resected group, 1, 3, 5 yar-survival rate was 58.8%, 13.3% and 7.1% respectively. In contrast to it, 1 year survival rate was 22.2% and anyone didn't survive
two
years in palliatively resected group.
The survival rate was higher for the lesion in lower one third than that of upper one third and diffuse type. Patients with well-differentiation had better survival rate than those with moderate and poor differentiation types. The mean survival
length
was 9.6 months in stage II, 13.8 months in stage III and 8.5 months in stage IVa.
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