Palliative decompression of obstructive hilar malignancies utilizing an extrahilar biliary approach

Hilar cancers carry a dismal prognosis. Palliation of obstructive jaundice in patients with hilar cancer can be achieved by either surgical or nonsurg ical means. Selection of the appropriate palliative measures is a challengi ng problem. Segmental bilioenteric anastomosis procedures were performed on 19 patients with hilar cancer. Seventeen of the bypasses were done to the segment III duct, known as the ligamentum teres approach, and two bypasses were to the segment V duct. Five patients, who had already been stented per cutaneously or endoscopically, were operated on after the stents were clogg ed and a duodenal obstruction ensued. There were two postoperative deaths ( 10.5%) and four postoperative complications (21%). All of the 17 surviving patients experienced improvement in the level of jaundice postoperatively a nd the levels of serum total and direct bilirubin decreased by 78.9% and 84 .2%, respectively. Two patients developed late cholangitis before death and were treated by external biliary drainage; one developed duodenal obstruct ion and was treated by gastrointestinal anastomosis. The mean length of hos pital stay was 15.2 days. Mean survival was 8.2 months and the mean period of well-being was 7.8 months. Median survival was 7 months and median perio d of well being was 7 months. Three patients are still alive at 8, 8, and 2 4 months. These data suggest that the ligamentum teres approach offers effe ctive palliation for patients with unresectable hilar cancer.