Selection of Operative Procedure According to Preoperative Diagnosis in Cancer of the Bile Duct

Seiki Tashiro, Tatsuya Tsuji, Keiichiro Kanemitsu, Yukio Kamimoto, Takehisa Hiraoka, Yoshimasa Miyauchi

The First Department of Surgery, Kumamoto University Medical School

We reviewed the records of 85 patients who underwent tumor resection for cancer of the bile duct and analyzed the selection of operative procedures according to the preoperative diagnosis of the cancer's spread. As the mode of spread of cancer of the lower bile duct, spreading along the bile duct to the hepatic duct was observed in some cases and microscopic examination revealed cancer cells in the plexus around the superior mesenteric artery in n₀ cases. The outcome after pancreatoduodenectomy (PD) combined with intraoperative radiotherapy (IOR) was better than after PD alone. As the mode of spread of cancer of the middle bile duct, the portal vein was likely to be invaded anatomically. Spreading also occurred along the bile duct to the hepatic side and/or to the duodenal side. The rate of radical resection in the bile duct resection group was about 20% and the outcome was very bad. The rate of radical resection in PD was 67%, but the outcome was not very good. Therefore PD combined with portal vein resection and/or IOR, including resection of the right and left hepatic duct separately, should be selected for cancer of the middle bile duct. Major liver resection combined with caudate lobectomy was better than bile duct resection in view of the longer survival of patients with cancer of the proximal bile duct. Right-sided resection of the liver was the procedure performed most often (about 67%). This was because the right hepatic duct is short and the tumor is more likely to invade the right hepatic artery than the left. Major hepatic resection combined with caudate lobectomy should be performed for cancer of the proximal bile duct.

Key words
cancer of the bile duct, preoperative diagnosis, selection of operative procedure

Reprint requests
Seiki Tashiro The First Department of Surgery, Kumamoto University Medical School
1-1-1 Honjo, Kumamoto, 860 JAPAN

Accepted
November 20, 1991

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