EXPERIENCE WITH DISTAL BILE-DUCT CANCERS IN US VETERANS AFFAIRS HOSPITALS - 1987-1991

Background: Treatment selection and results were reviewed in a populat ion with distal bile duct cancers. Method: Cases of bile duct cancer w ere retrieved from computerized U.S. Department of Veterans Affairs re cords from 1987-1991. Result: A total of 156 patients with distal bile duct cancers were recovered (34 resections, 37 operative bypasses, an d 85 nonoperative biliary intubations). Mean survival after resection was 22 months, which was significantly higher than after biliary bypas s (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 su rvival rate after resection was 21% for localized cancers, but no 3-ye ar 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 i n cure and prolonged survival also can occur without resection. (C) 19 97 Wiley-Liss, Inc.