The gall baldder(GB) cancer and the extrahepatic bile duct(EBD) cancer are uncommon. Despite advances in the diagnosis and treatment the overall prognosis remains poor due to late diagnosis and direct extension of the tumor to the adjacent vital
organs.
This study is an analysis of the 51 cases of the GB cancer and the 58 cases of the EBD cancer which were operated at the Department of Surgery, Korea University Hospital from january, 1985 to January, 1993.
The peak incidence was 6th decade and the male to female ratio 1 : 1.1 in the GB cancer and the peak incidence was 5th decade and the male to female ratio was 2.2 : 1 in the EBD cancer. Abdominal pain(74.5%%) in the GB cancer and jaudice(75.4%)
in
the
EBD cancer were the predominant clinical features. The diagnostic accuracy of the GB cancer were 80.0% in ERCP, 50.0% in PTC, 48.1% in CT and 23.8% in US, whereas that of the EBD cancer were 85.7% in PTC, 67.5% in ERCP, 63.4% in CT and 36.2% in
US.
The
performed operative procedures were exploratory ladparotomy (15.6%), palliative resection(29.4%), curative resection (31.4%), bypassop (15.7%) and external drainage(7.8%) in the GB cancer. Those of the EBD cancer were exploratory
laparotomy(3.3%),
palliative resection(27.6%), curative resection(29.4%), bypass-op.(20.8%), and external drainage (18.9%). The pathologic stage of the GB cancer were 9.6% in stage I, 9.6% in stage II, 13.5% in staged III, 36.5% in stage Iva 30.8% in stage Ivb and
the
stage of the EBD cancer were 8.5% in stage I, 8.5% in stage II, 8.5% in stage III, 61.0% in stage Iva, 13.6% in stage Ivb. The mean duration of survival was 9.7 months in the GB cancer and 11.4 months in the EBD cancer(7.1 months in upper third,
12.3
months in middle thrid, 15.8 months in lower third and 6.2 months in diffuse bile duct cancer). The cumulative 5 year survival rate(YSR) of the GB cancer according to operative procedures were 14.6% in exploratory laparotomy, 8.7% in palliative
resection and 47.9% in curative resection. The cumulative 5 YSR of the EBD cancer were 20.2% in bypass-op 0% in palliative resection and 23.6% in curative resection. The cumulative 5 YSR of the GB cancer according to pathologic stage were 100% in
stage
I, 50.0% in stage II, 37.5% in stage III, 15.1% in stage Iva and 22.9% in stage Ivb. But in the EBD cancer, the pathologic stages wer not significantly correlated with the cumulative 5 YSR.
As a result of this study, it is concluded that early detection and curative resection provides the longest palliation and offers potential for cure of the GB and EBD cancer.
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