Carcinoma of the extrahepatic bile ducts: a ten year experience in Hawaii

A ten year review (1966-1975) of extrahepatic bile duct carcinoma in three major Honolulu hospitals is presented. Fifty-seven patients satisfied the criteria for the study. The disease occurs predominantly in the Japanese population. Survival of patients with upper third lesions proximal to the cystic duct is poor, and all patients followed died within seventeen months of hospitalization or operation. In patients undergoing bypass procedures for lower third (intrapancreatic) lesions, palliation averages ten months. The Whipple operation, performed in fourteen selected patients with favorable lesions, affords palliation averaging twenty months, and five patients were long-term survivors, including two with five year cures. However, morbidity and mortality for the Whipple procedure is high. Methods for improving palliation in upper third lesions and lowering morbidity and mortality from pancreatoduodenectomy are proposed.