[Surgical treatment for the upper and middle bile duct cancer]

A total of 45 patients with bile duct cancer, 13 patients predominantly with Bs bile duct cancer, 14 with Bm cancer, and 18 with Bim cancer, were chosen from 104 patients with bile duct cancer, not including gallbladder cancer or cancer of the papilla of Vater, who underwent surgical resection in our department between Sep 1974 and Nov 1996, and were evaluated with respect to surgical procedure, pathological findings, and outcome. The patients with Bs cancer were compared with 39 patients with cancer of the main hepatic duct junction who underwent hepatectomy, and the patients with Bim cancer were compared with another 20 patients with Bi bile duct cancer. The effect of combined resection of the vessels and hepatopancreatoduodectomy (HPD) on patients with advanced cancer was assessed. To attain a hw (-) margin, hepatectomy should be performed in patients with Bs bile duct cancer, unless localized. Bm and Bim bile duct cancer patients with negative margins had a relatively favorable outcome irrespective of surgical procedure. Resection of the vessels and HPD were useful in improving the resectability rate, but not in attaining longer survival.