Carcinoma of the hepatic hilus. Surgical management and the case for resection

Tumor resection for treatment of carcinoma of the hepatic hilus was preferred over routine palliative decompression at the University Hospital Center, Rennes, France, in 1974. Since then, resection has been performed on 18 patients. In seven of these patients resection proved impractical because of the extension of a neoplasm into the portal vein or liver, therefore palliative decompression was performed. In 11 patients (61%) tumor resection, followed by reconstruction of the biliary tree, was performed successfully. All the resected tumors were adenocarcinomas of the proximal bile ducts. Four patients had simple hepatic duct resection. In two patients duct resection was associated with right lobectomy, in three patients with left lobectomy, in one patient with segmentectomy, and in one patient with excision of the right branch of the hepatic artery. There were two postoperative deaths. The mean survival time for the remaining nine patients is 521 days. Five patients were alive in August 1978, at intervals ranging from 175 to 1180 days after resection. These results contrast favorably with those obtained between 1968 and 1973, during which period nine patients had palliative decompression, with three postoperative deaths and a mean survival time of 164 days for the remaining six patients.