CLINICAL PRESENTATION, DIAGNOSIS AND SURVIVAL OF RESECTED DISTAL BILE-DUCT CANCER

The aim of the study was the definition of the clinical features and s urvival of 27 resected cases of distal bile duct carcinoma. This neopl asm accounted for 14% of all periampullary malignancies treated by pan creaticoduodenectomy between 1990 and 1996. Jaundice was present in 96 % of patients, but was the first symptom only in 78%. Preoperative inv estigations allowed to recognize distal bile duct cancer in a minority of patients (41%). Operative mortality and morbidity were 3.7 and 44% , respectively. Most patients (88%) were assigned to UICC stage IV-A. Postoperative survival was not significantly better than survival of 1 01 patients undergoing pancreaticoduodenectomy for pancreatic ductal c arcinoma; median survival was 22 months, with a 13% 5-year survival ra te. Determinants of a better prognosis were UICC stage <IV-A (p = 0.05 ) and absence of lymphatic invasion (p < 0.01); prognostic significanc e of nodal involvement, tumor grading, perineural invasion, tumor size , pylorus preservation and adjuvant therapies could not be proven. Lym phatic invasion was the strongest determinant of survival on multivari ate analysis (p < 0.01).