Retrospective Analysis Of 73 Patients With Extrahepatic Bile Duct Carcinomas

Objective: To summarize methods for diagnosis and treatments of patients with extrahepatic bile duct carcinomas. Methods: Retrospective analysis based on clinicopathology, diagnostic methods, surgical approaches and follow-up data, were carried out for 73 consecutive patients with extrahepatic bile duct carcinomas treated in our hospital between January 1995 and March 2004. In this series, there were 49 (67.1%) for upper-third carcinomas, 13 (17.8%) for middle-third carcinomas, 10 (13.7%) for lower-third carcinomas and 1 (1.4%) for diffuse carcinomas. Results: The 79.5% of the patients were between 50~79 years old, the same percentage was observed in the patients with progressive jaundice as initial symptom. The rate of pre-admission misdiagnoses and the accuracy of preoperative diagnoses were 40.1% and 95.9% respectively. Diagnostic accuracy was 81.9% (59/72) forultrasonography (US), 84.2% (27/31) for CT, 93% (40/43) for MRI+ MRCP(magnetic resonance cholangiopancreatoraphy), 88.9% (16/18) for percutaneous transhepatic cholangiography (PTC), 93.5% (29/31) and 100% (14/14) for US+CT and US+CT+MRCP respectively. Diagnoses of 35 patients were confirmed by exploration and biopsy which showed 94.3% for adenocarcinomas and 5.7% for adenosquamous carcinomas respectively. Of the 73 patients, 47 (64.4%) underwent operation, 11 were peformed with interventional drainage including percutaneous transhepatic choledochal drainage (PTCD) and endoscopic stenting, and 15 late stage patients refused treatmental procedure. In the operation group, 22 (46.8%) underwent resection (5 for curative resection and 7 for palliative resection), and 27 were employed internal or external drainage. There were no statistical difference between the two groups on operative morbidity (45.5% versus 40%) and morality (13.6% versus 8%). The median actuarial survival (operative deaths excluded) was 26 months ( 1.2 to 69+ months ) for resective surgery (n=15 patients ) , 8 months (1.8~ 15+ months) for surgical drainage and 5.5months (2~20months ) for interventional drainage (p<0.05). All of the untreated patients were died in 4 months after clinically diagnoses. Surgical and interventional drainage could somehow improve the living quality and survival of unresectabel patients. Conclusions: As for extrahepatic bile duct carcinomas, early diagnosis was still a hard problem and the misdiagnostic rate at the first admission has kept higher. However, combined adoption of the current noninvasive imaging methods could improve early diagnosis, preoperative confirmation, tumor resectability and proper operation designing. Resection can be considered as the most effective approach and the only curable chance for some patients, and surgical drainage may be best alternative for unresectable cases.