The Long-term Results Of Managements In 182 Cases Of Extrahepatic Biliary Carcinomas

Background: Carcinoma of the extrahepatic biliary tract is a rare neoplasm and is associated with a dismal prognosis. To analyze the natural history of these disease , prognostic factors and investigate the measures of diagnosis and treatment.Methods: 182 cases ( gallbladder carcinoma 98 ,extrahepatic bile duct carcinoma 84) admitted into our hospital from January 1992 to July 2000 were followed up, and clinical features^ managements and follow-up results of these patients were analyzed retrospectively. All statistical analyses were performed with SPSS 10.0 statistical package. Survival figures were estimated by the Kaplan-Meier method and differences among groups were tested by the log-rank test. The Cox multivariate analysis was performed to determine prognostic factors for improved survival.Results: Among 182 patients, with a mean follow-up time of 478 days, 72 (gallbladder:36, bile duct:36) were radical resection, 74 (gallbladder:43,bile duct:31) were palliative surgery and 36 were treated by chemo- and/or radiotherapy. The overall 5-year survival rate of the gallbladder carcinoma was 4.45%, while the 5-year survival rate of the bile duct carcinoma was 13.11%, but there was no significant difference(p=0.18). The 1-.. 3-^ and 5-year survival rate following radical resection for gallbladder cancer was 76.57%, 34.15%^ 14.23%respectively, remarkably higher than that of the groups of palliative surgery and nonoperation(p=0). So is it with bile duct cancer(p=0.012, 0.011), it's 1-, 3-^ and 5-year survival rate following radical resection was 61.76%^ 40.0%, 21.94% respectively. Muhivariate analysis revealed that T and therapeutic interventions had sifhificantly higher risk ratios for gallbladder cancer, and lymph node(N) and distant metastasis(M) had almost significant risk ratio(p=0.053, 0.084).while for bile duct carcinoma, The factors producing the greatest risk were histopathological grade followed by distant metastasis(M), therapeutic interventions and T had almost significant risk ratio(p=0.057, 0.088)Conclusions: The prognosis of the extrahepatic biliary carcinoma is still not good, even if radical resection is performed. With careful patient selection, aggressive resection may help to improve the prognosis. Resection alone is inadequate for a significant improvement in survival, there is now a need to evaluate more effective adjuvant therapy in the form of radiotherapy or newer chemotherapeutic agents. Emphasis to improve the long-term survival should be pay on early diagnosis and early management.