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KMID : 0371319950480030410
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Journal of the Korean Surgical Society
1995 Volume.48 No. 3 p.410 ~ p.415
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Clinical Significance of Preoperative Determination of the Proximal Extent of Invastion in Bile Duct Carcinoma
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Abstract
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There is an increasing tendency of combined resection of liver and pancreas for bile duct carcinomas recently. But careful preperation for operation should be done dsince the complication rate is high. It is unreliable to determine the extent of
proximal bile duct invasion by frozen biopsy during operation, especially in the case of polypoid types of bile duct carcinoma. The polypoid carcinomas spread fairly long distance along the ductal wall without any invasion to deeper layer in some
cases.
We experienced 8 cases of superficially spreading type bile duct cancer recently. Mean age was 62.3 years and there was only one female patient. Pancreaticoduodenectomy was done in 4 cases and segmental resection of bile duct with
hepaticojejunostomy
was performed in 3 cases. One patient rceived left hepatic lobectomy and caudate lobectomy. Frozen biopsy of proximal duct resection margin was done in all cases during operation and the results were free of cancer cell. However final pathologic
examination revealed that 5 cases had cancer cells on the proximal resection margin, although the resection margins were apart from main lesion in the range of 1.5~4cm. Preoperatvie cholangiography failed to detect the proximally spread lesions.
We
applied percutaneous transhepatic cholangioscope(PTCS) to 8 cases of polypoid bile duct cancer preoperatively, in which PTCS with biopsy was greatly helpful in determining the extent of invasion along the proximal mucially polypoid types, to
determine
the resectability and extent of surgery, since a significant proportion of them are superficially spread far more proximally than expected.
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KEYWORD
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