[Surgical and endoscopic management of bile duct cancer]

There is still considerable controversy regarding the value of surgical versus nonsurgical treatment for bile duct cancer. Therapeutic modalities vary from total hepatectomy and liver transplantation to percutaneous or endoscopic stent insertion. The aim of this study was to assess the results of the treatment of 118 patients presented with bile duct cancer in the Department of Surgery, University of Szeged, during the time period 1990-2002.

The age, male/female ratio, postoperative morbidity and mortality were analyzed.

The resectability rate was 18% (21/118). The mortality rate was 23.8% (5/21) after radical operations and 7% or 12.5% after the palliative procedures. 67 patients had palliative surgery following unsuccessful or recurrent jaundice after non-surgical palliation. The previously applied palliative methods have been transpapillary stenting, endoscopic pig-tail drainage, percutaneous transhepatic drainage or dilatation.

Palliative surgery for jaundice caused by extrahepatic bile duct cancer is justified in cases with an unsuccessful attempt for endoscopic stenting or occlusion of endoscopically placed endoprothesis. Bilio-enteric bypass with a Roux-Y jejunal loop is superior than external drainage respecting desicterization, postoperative recovery, mortality, complication rate and quality of life.