AIMS To evaluate clinically the surgical procedures and their in- fluence on the prognosis of extrahepatic bile duct cancer. METHODS A total of 55 patients with pathologically and clini- cally verified extrahepatic bile duct cancer treated in our depart- ment between January 1984 and December 1993 were retrospec- tively analyzed.Clinical courses with respect to the surgical pro- cedures employed and the survival period of these patients were followed up and compared. RESLUTS Of these patients,24 involved the upper third of ex- trahepatic biliary tract,12 the middle third,and 19 the lower third.Diagnosis of bile duct cancer was confirmed histopatholo- gically in 42 patients,with a clear predominance of adenocarcino- ma(97.6 percent).Eleven(26.2 percent)patients received cu- rative resection;30 received palliative procedures,i.e.,biliary- enteric bypass(n=14)and external drainage(n=16);6 re- ceived permanent PTCD alone and 8 received exploratory laparo- tomy only or conservative treatment.Forty-eight patients(87.3 percent)were followedup.The overall mean survival period was 10.8±9.7months(±s);patients with curative resection had the longest survival period(21.4±16.7 months,±s,P<0. 01)and highest survival rate(P<0.05);a significant survival difference was observed in patients with biliary-enteric anastomo- sis compared with those with external drainage,ect.(P<0. 05);but there was no significant difference in survival period be- tween patients having PTCD(n=23)and not(n=26)prior to surgery(P>0.05). CONCLUSIONS Curactive resection is the treatment of choice for suitable patients with extrahepatic bile duct cancer;biliary-en- teric anastomosis is preferable in those with unresectable tumor in order to improve the prognosis and quality of life.
