Carcinoma of the gallbladder and bile ducts. A retrospective review

In retrospective review, 31 patients with carcinoma of the gallbladder and 39 patients with carcinoma of the extrahepatic bile ducts (excluding ampullary tumors) were identified. Case records and operative reports of patients seen between 1955 and 1980 were reviewed for the purpose of evaluating clinical features, preoperative studies, and operative treatment of these two disease processes. Similarities and differences between the two malignancies are highlighted. Demographic features of these patients supported findings of previous studies. Preoperative symptoms were typical of calculus disease often with the stigmata of malignancy superimposed. Laboratory findings provided a rather nonspecific confirmation of cholestasis. Roentgenogram examinations proved to be of little value in differentiating either disease process. A variety of surgical procedures was used by several surgeons to attempt cure or palliation in these tumors. Cholecystectomy was the most frequent procedure performed for patients with gallbladder carcinoma (18 cases). Curative cholecystectomy yielded an average 17.8 month survival. More radical procedures produced higher survival rates although the study size is of questionable statistical significance. Biliary-enteric bypass (choledochojejunostomy) was performed most often for patients with bile duct carcinoma (12 cases). The magnitude of the operation failed to affect the duration of patient survival except in patients with carcinomas of the distal common bile duct. Three Whipple procedures were performed for distal bile duct lesions yielding the one five-year survivor of this study but with an associated 30 per cent operative mortality. Operative strategy and options are discussed. The current literature dealing with these two malignancies is reviewed.