Carcinoma of the extrahepatic bile ducts

The records of patients with carcinoma of the extrahepatic bile ducts, including the ampulla of Vater, operated on at the University of Rochester Medical Center between 1960 and 1980 were reviewed. All 47 patients had similar manifestations and laboratory findings; percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography were the two studies that consistently localized the tumor. Seven of eight patients with carcinoma of the ampulla underwent pancreaticoduodenectomy. At this writing five are alive and well without evidence of recurrence (a mean of 47 months). Twenty-three tumors were located at or proximal to the confluence of the right and left hepatic ducts; 16 were distal to this point. The six patients with distal lesions that were resected had a mean survival time of 14 months; the mean survival time was 7 months for the six patients in whom the operation was restricted to drainage of the proximal duct. Of the group of patients subjected to exploratory surgery and biopsy only, none survived longer than a month. Resection was carried out in only one patient for a proximal lesion; this patient died 28 months after the operation. Patients with proximal lesions who underwent drainage procedures lived an average of 7.6 months. In all groups several was longer in patients without metastases at the time of operation. The survival time after the resection was significantly longer than that associated with drainage, which suggests a more aggressive approach to these lesions.