Aggressive Surgical Approaches to Advanced Carcinoma of the Biliary Tract

Masato Nagino, Yuji Nimura, Naokazu Hayakawa, Junichi Kamiya, Satoshi Kondo

First Department of Surgery, Nagoya University School of Medicine

Forty-five patients with far advanced (stage-IV) gallbladder carcinoma and 52 patients with carcinoma of the hepatic hilus who had undergone radical resection were studied. Various hepatic segmentectomies were used in 85 patients (87.6%). Furthermore pancreatoduodenectomy and/or portal vein resection were concomitantly performed in 19 patients (19.6%) and 24 patients (24.7%), respectively. In stage-IV gallbladder carcinoma, the survival time of the patients with peritoneal seeding, liver metastasis, or positive paraaortic nodes was extremely poor (3-year survival rate was 5.6%, 50% survival time was 9.8 months). By contrast, the survival of the patients without seeding, liver metastasis, or positive paraaortic nodes was unexpectedly better (5-year survival rate was 32.8%). In carcinoma of the hepatic hilus, the survival time of the patients with stage-I, -II, and-III was satisfactory (s-year survival rate 43.3%). Although the prognosis for the stage-IV patients was significantly worse (5-year survival rate was 21.5%), there were many long-term survivors among the patients with stage-IV with local staging factors such as hinf, ginf, or vs (+). In conclusion, we believe that aggressive surgery with more adequate indication and further improvement of operative techniques will give a better prognosis for patients with advanced carcinoma of the biliary tract.

Key words
stage-IV carcinoma of the gallbladder, carcinoma of the hepatic hilus, hepatic segmentectomy

Reprint requests
Masato Nagino First Department of Surgery, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
December 9, 1992

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