Clinicopathological characteristics of hepatic hilar bile duct carcinoma

We reviewed thirty cases of hepatic hilar bile duct carcinoma found in 5,800 consecutive autopsy cases, mainly of the aged, and analysed their clinicopathological characteristics. Eleven cases had a record of tumor resection (8 men, 3 women, mean age 75.1 years). At operation, the gross type was mainly infiltrative in all eleven cases, and the stage was II, III or IV in as many as ten cases. Cholecystectomy and bile duct resection were performed in all cases except one in whom additional hepatic lobectomy was performed. In none of the cases was the operation curative. The main cause of non-curability was residual carcinoma on the surgical cut or ablated surface due to longitudinal or lateral cancerous interstitial spread. This was confirmed by the fact that local relapse of carcinoma, either in the hepatic hilus or hepatoduodenal ligament, was found in all the cases at autopsy. This fact also indicates the difficulty in achieving complete resection of carcinoma in this part. On the other hand, a relatively "benign" aspect of hepatic hilar bile duct carcinoma was suggested as follows: 1. Most of the cases were well-differentiated adenocarcinoma. 2. Although there was no case of curative resection, three out of of nine cases (excluding the cases of death during operation) survived more than two years. 3. Distant metastasis found at autopsy was relatively rare, being seen in four of these eleven cases. In the light of these data an operation, even though palliative, is considered to be justified.