Carcinoma of the bile ducts

Seventy-nine patients with carcinoma of the bile ducts were treated at this clinic between 1958 and 1977. In 36, the tumors were at the bifurcation of the hepatic ducts, ten were in the common hepatic duct, 32 were in the common bile duct and one tumor was in the cystic duct. In one patient, carcinoma arose in a choledochal cyst. Percutaneous transhepatic cholangiography was the preferred preoperative diagnostic study. Metastases were observed in 18 patients at operation. Nine patients underwent resection of the tumor; 58 patients had intubation or a bypass procedure and 12 had biopsy only. Radiation therapy was given to 16 patients; 18 received chemotherapy. Three of 36 patients with tumors at the bifurcation of the hepatic ducts survived longer than two years; one of these three patients is still alive five years after intubation and radiation therapy. Three of 43 patients with carcinoma below the bifurcation survived five years. Resection of the tumor is the preferred method of treatment. If resection cannot be performed, intubation through the tumor or a biliary bypass with intensive radiation therapy is preferred.