PALLIATIVE TREATMENT OF EXTRAHEPATIC BILE-DUCTS TUMORS

Extrahepatic bile duct (EHBD) tumors often become symptomatic in an ad vanced stage when curative resection is seldom possible. In a group of 111 patients, 7 (6.3%) received no treatment, 32 (28.8%) underwent no n-operative biliary drainage (NOD), and 72 (64.8%) underwent surgical exploration. Radical resection was possible in only 25 cases (34.7%); 14 patients (19.4%) underwent a biliary digestive bypass (BDB), 15 (20 .8%) received a transtumoral biliary prosthesis (TBP), and 18 (25.0%) an external biliary drainage (EBD). Average survival rates were: 6.5 m onths after BDB, 4.0 months after TBP, and 2.8 months after EBD. In a second group of 2,066 patients with primary and secondary malignant ob struction of the upper EHBD, treated with the insertion of a Carey-Coo ns transhepatic transtumoral biliary prosthesis, the average survival was 4.3 months. The early morbidity rate was 0.6%. Obstruction of the prosthesis occurred in 91 patients (4.4%), and the late morbidity rate was 3.6%. Although EHBD tumor treatment results are generally poor, s urgical exploration should be performed in all patients with acceptabl e surgical risk, and without evidence of disseminated disease. When re section of the tumor is not feasible, we favor the use of a BDB or of a biliary prosthesis over that of an external drainage. In poor risk c ases or cases with evidence of disseminated disease, we prefer the pla cement of an internal prosthesis (PTBD or endoscopic.