NEWER TECHNIQUES IN THE DIAGNOSIS AND TREATMENT OF PROXIMAL BILE-DUCT CARCINOMA - AN ANALYSIS OF 41 CONSECUTIVE PATIENTS

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  • 1 January 1981
    • journal article
    • research article
    • Vol. 50  (199) , 247-258
Abstract
The clinical course of 41 consecutive patients with primary bile buct carcinoma at or near the liver hilum was analyzed to determine whether the outcome was improved by newer techniques of diagnosis and treatment. The age was wide, with 1/3 under 50 yr. The only etiological factor identified was long-standing ulcerative colitis (present in 9.8% of patients). In 1/3 of patients initial symptoms were misleading. The tumor was missed in 11 (61%) of 18 patients undergoing an exploratory laparotomy at other hosptials, despite operative cholangiography. None had pre-operative percutaneous cholangiography which was the best investigatory technique, giving the correct diagnosis in all cases in whom it was performed. Greyscale ultrasonography was useful and endoscopic retrograde cholangiography less so. Median survival in those treated by surgical T- or U-tube drainage (21 patients) or bypass (3) was 9 mo. from diagnosis, as opposed to 3 mo. in the 36.5% of patients in whom biliary drainage was not obtained. Radiotherapy, including insertion of a radioactive Ir wire through the tumor via a T- or U-tube or percutaneously, was performed in 9 patients and improved the duration of survival compared with tube drainage alone. The new percutaneous techniques offer a useful alternative to surgery for palliative drainage and radiotherapy.