Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts

Analysis of the surgical management of 94 consecutive patients with carcinoma at the confluence of the hepatic ducts showed that 20% of them (or 60% of those thought, after comprehensive pre-operative investigation, to have resectable lesions) underwent tumour resection--6 local resections and 12 liver resections. The 30-day hospital mortality was 11% and mean duration of survival was 17 months (7 patients are still alive, with a mean survival of 22.2 months). The quality of life was also much improved after resection. In patients treated with palliative surgery the hospital mortality was 33% and the mean survival was 8.5 months. The results support the treatment of bile-duct carcinoma at the hilum of the liver by resection and suggest that the use of drainage techniques, whether employed surgically or non-surgically, be reserved until the possibility of treatment by resection has been fully considered.