Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts

Abstract

Analysis of the surgical management of 94 consecutive patients with carcinoma at the confluence of the hepatic ducts showed that 20% of them (or 60% of those thought, after comprehensive pre-operative investigation, to have resectable lesions) underwent tumour resection--6 local resections and 12 liver resections. The 30-day hospital mortality was 11% and mean duration of survival was 17 months (7 patients are still alive, with a mean survival of 22.2 months). The quality of life was also much improved after resection. In patients treated with palliative surgery the hospital mortality was 33% and the mean survival was 8.5 months. The results support the treatment of bile-duct carcinoma at the hilum of the liver by resection and suggest that the use of drainage techniques, whether employed surgically or non-surgically, be reserved until the possibility of treatment by resection has been fully considered.