Surgical management of primary bile-duct carcinoma

Primary bile-duct carcinoma is a rare lesion, causing death from hepatic failure due to biliary obstruction. Between 1976 and 1983, 22 patients with this tumour were treated at the Sunnybrook Medical Centre in Toronto. Thirteen patients had unresectable proximal bile-duct carcinoma of the high type. Distal bile-duct carcinomas in three patients were not resected because of metastatic disease. Three proximal bile-duct carcinomas of the low type and three distal bile-duct carcinomas were resectable. A new method of internal biliary decompression is presented, for palliation in patients with proximal bile-duct carcinoma of the high type. An intraluminal polyethylene stent has produced satisfactory quality of life with a mean survival of 16 months in eight patients; two others are alive with disease, 9 and 19 months after placement of a stent. Satisfactory palliation of distal, unresectable lesions can be achieved by biliary intestinal anastomosis in some cases.