Surgical Management for Advanced Biliary Tract Carcinoma

Tatsuya Yoshikawa

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College

This paper reviewed the present status of surgical management for advanced biliary tract carcinoma including stage IV gallbladder carcinomas and bile duct carcinoma in Japan. I Gallbladder carcinoma: As for the liver resection, systematic resection of the liver according to the region of invasion should be performed for the liver bed type, the hepatic hilum type was an indication for extended right lobectomy including the caudate lobe. Pancreatoduodenectomy (PD) was indicated for direct invasion to the duodenum or the head of the pancreas. The indication of PD was still controversial. We have undergone PD for associated lymph node with a high incidence of metastasis, which was resectable only by PD. The prognosis of the patients with positive cancer invasion in hepatoduodenal ligament was extremely poor. Entailed extended lobectomy, hepatoduodenal ligamentectomy, and pancreatoduodenectomy (hepatoligamento-pancreatoduodenectomy: HLPD) was attempted, however, further experience should be required before HLPD could be objectively evaluated. II. Bile duct carcinoma: Among the patients with bile duct carcinoma, PD was commonly indicated for distal and middle bile duct carcinoma. The characteristics of cancer in hilar region have not resulted in standard operation, had to undergo appropriate liver resection based on precious preoperative diagnosis of cancer extent, consequently lobectomy of liver was unavoidable, because of many patients with advanced carcinoma of the hilum. Hospital death and morbidity rate varied according to the extent of hepatic resection, extended right lobectomy and HPD with right lobectomy was associated with a high mortality and morbidity rate, therefore, the indication of extended lobectomy or HPD wih extended lobectomy should be circumspect. We concluded that even advanced biliary tract carcinoma, which was localized, extended operation was significant, because long survival could be obtained.

Key words
advanced gallbladder carcinoma, advanced bile duct carcinoma, surgical treatment

Reprint requests
Tatsuya Yoshikawa Department of Surgeyr, Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
May 21, 1997

To read the PDF file you will need Abobe Reader installed on your computer.