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Experience with distal bile duct cancers in U.S. Veterans Affairs hospitals: 1987-1991
T P Wade1, C N Prasad, K S Virgo
1Department of Surgery, John Cochran VA Medical Center, St. Louis, MO, USA.
Background:
Treatment selection and results were reviewed in a population with distal bile duct cancers.
Method:
Cases of bile duct cancer were retrieved from computerized U.S. Department of Veterans Affairs records from 1987-1991.
Result:
A total of 156 patients with distal bile duct cancers were recovered (34 resections, 37 operative bypasses, and 85 nonoperative biliary intubations). Mean survival after resection was 22 months, which was significantly higher than after biliary bypass (14 months) or intubation (11 months). Death rate within 30 days of resection, bypass, or intubation was 11%. Distal bile duct cancer had a much higher resectability rate (48%) than did pancreatic cancer (22%) and significantly longer mean survival by stage. Projected 5-year survival rate after resection was 21% for localized cancers, but no 3-year survivors were seen with nodal metastases regardless of treatment.
Conclusions:
Resection increases survival in patients with distal bile duct cancer. Five-year survival was achieved only when patients when nodal or other metastases were absent; most resections do not result in cure and prolonged survival also can occur without resection.