Carcinoma of the extrahepatic bile ducts : the University of California at San Francisco experience

• Published in: Annals of surgery Vol. 219; no. 3; pp. 267 - 274
• Main Authors: SCHOENTHALER, R, PHILLIPS, T. L, CASTRO, J, ELFIRD, J. T, BETTER, A, WAY, L. W
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.03.1994
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - radiotherapy; Bile Duct Neoplasms - surgery; Bile Ducts, Extrahepatic - surgery; Biological and medical sciences; Combined Modality Therapy; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Neoplasm Staging; Radiotherapy Dosage; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Antineoplastic agent; Human; Chemotherapy; Carcinoma; Treatment; Extrahepathic bile duct; Surgery; Digestive diseases; Surgical resection; Malignant tumor; Biliary tract disease; Radiotherapy
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199403000-00006

The authors investigated the combined experience of a single institution in treating bile duct carcinoma during the modern era. Bile duct carcinomas are notoriously difficult to cure, with locoregional recurrence the rule, even after radical resection. Adjuvant efforts have included various radiation modalities, with limited success. Recently, charged-particle radiotherapy has also been used in these patients. The authors performed a retrospective chart analysis of 129 patients with bile duct adenocarcinomas treated between 1977 and 1987 through the University of California at San Francisco, including 22 patients treated at Lawrence Berkeley Laboratory with the charged particles helium and neon. The minimum follow-up was 5 years. Survival, outcome, and complication results were analyzed. Sixty-two patients were treated with surgery alone (S), 45 patients received conventional adjuvant x-ray radiotherapy (S + X), and 22 were treated with charged particles (S + CP). The median survival times were 6.5, 11, and 14 months, respectively, for the entire group, and 16, 16, and 23 months in patients treated with curative intent. There was a survival difference in patients undergoing total resection compared with debulking (p = 0.05) and minor resections (p = 0.0001). Patients with microscopic residual disease had increased median survival times when they were treated with adjuvant irradiation, most markedly after CP (p = 0.0005) but also with conventional X (p = 0.0109). Patients with gross residual disease had a less marked but still statistically significant extended survival (p = 0.05 for S + X and p = 0.0423 for S + CP) after irradiatio The mainstay of bile duct carcinoma management was maximal surgical resection in these patients. Postoperative radiotherapy gave patients with positive microscopic margins a significant survival advantage and may be of value in selected patients with gross disease.