J.Jpn. Surg. Soc.. 83(9): 852-855, 1982

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Report on the annual meeting

TREATMENT OF CARCINOMA AT THE HEPATIC HILUS OF THE BILE DUCTS

From January 1976 to February 1981, 29 patients with carcinoma at the hilus of the bile ducts were treated at Tsukuba University Hospital and Chiba Cancer Center Hospital. Surgical resection was performed upon 11 of the 29 patients. Four of these 11 patients underwent resection of the hepatocholedochus, including the major intrahepatic bile ducts. In three patients, a left hepatic lobectomy was performed, combined with excision of the tumor. And the remaining 4 patients had received a right hepatic lobectomy.
Three of the four patients who had received bile duct resection died from metastatic lesions 9 months,12 months and 54 months after resection, respectively and the remaining one patient died from fulminant hepatitis 4 months after surgery. Contrarily, three patients who underwent a left hepatectomy are alive and doing well at 36, 54 and 70 months after resection, respectively. Three of four patients who had received a right hepatectomy survived 4,4, and 25 months after surgery and only one patient is still alive with normal liver function 12 months after hepatectomy.
Other six in a series of 29 patients had received a combination therapy of surgical resection with simultaneous intraoperative radiotherapy.
A single dose of 2,250-3,500 rad is delivered to the lesion with 8-16 me V electrons from a betatron. Four of six patients underwent resection of the hile ducts and two received left or right hepatic lobectomy. Five of the six patients died from hepatic abscess and one from gastrointestinal bleeding, at various times during periods from 20 days to 16 months after surgery. The combination therapy of surgical resection with radiotherapy caused lethal cholangitis and resulted in worse outcome of the patients as compared with the patients who had received only surgical resection or intraoperative radiotherapy. Further investigation should be done to improve the outcome of patient with hilar bile duct cancer.

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