Malignant tumours of the bile-ducts

Abstract

The 77 cases of malignant neoplasm of the extrahepatic bile-ducts treated at the Lahey Clinic between 1965 and 1969 are reviewed. Exploratory laparotomy was performed in 68 cases, although in 9 cases operation was not indicated because of the patients' poor condition. Of the 68 surgical patients, 24 (35 per cent) had a radical procedure, of which 17 survived for more than 1 year and 5 are still alive more than 3 years later, 3 having no evidence of recurrent disease. Forty-one patients had palliative treatment usually with some form of decompression procedure of the obstructed common bile-duct, and in 15 patients this was combined with hepatic artery infusion chemotherapy. Of these patients, 16 survived for more than 1 year, including 9 from the group treated by hepatic artery infusion chemotherapy. Only 1 patient is still alive after more than 3 years. Of all the patients, 44 per cent survived for more than 1 year, 23 per cent for more than 2 years, and 8 per cent for more than 3 years. The mean survival time was 13 months. These results compare favourably with those of the previous survey from the Lahey Clinic, and it is concluded that the improvement is the result of the increase in the radical resection rate from 18 to 31 per cent and in the institution of hepatic artery infusion chemotherapy in palliative cases.