Bile duct carcinoma: Trends in treatment in the nineties

Surgical resection provides the only known chance of cure for cholangiocarc inoma, and even then the 5-year survival is only 10 to 20%, and only one-th ird of patients are resectable for cure at the time of diagnosis. In recent years we have had considerable experience with endoscopic stenting to pall iate common bile duct cancers. This has prompted us to evaluate our results for both endoscopic and surgical treatment of cholangiocarcinoma. From January 1990 through June 1999, we reviewed our endoscopic retrograde cholangiopancreatography registry and the hospital records for patients we treated for cholangiocarcinoma. Fifty patients were identified: 45 with cho langiocarcinoma and five with gallbladder cancer (who were excluded). The s urgical group consisted of 16 patients: in 14 patients, resection for cure was possible whereas two had palliative procedures. There was one mortality (6%) and the median survival was 16 months. There have been no long-term s urgical survivors, but 2 patients are alive at 24 months. We treated 29 pat ients with advanced disease with endoscopic stents (the endoscopic group) m ainly for relief of obstructive jaundice. Six of 29 patients in the endosco pic group were critically ill and died in less than 4 weeks, whereas 23 pat ients who were in better condition survived for a mean of 10 months (range 2-84 months). We conclude that for common duct bile cancer surgical resecti on remains the treatment of choice but is applicable in only 30 to 35 per c ent of cases, Endoscopic stenting effectively relieves jaundice and can pro vide long-term palliation comparable with surgical bypass; 12 of 29 patient s in our endoscopic group survived 12 months or longer, and one is alive at 84 months after initial stenting.