Surgical complications and treatment during resection for malignancy of the high bile duct

From January 1968 to January 1997 a series of 50 of 109 patients had underg one resection for high bile duct cancer in our institution in Rennes, Franc e. The overall operative mortality was 12%, but there were no deaths among those who had only tumor resection or those with hepatectomy with vascular reconstruction. The early complications were biliary fistula (four cases) a nd subphrenic abscess (three cases), of which two of the biliary fistulas r esulted in mortality. There were three gastrointestinal hemorrhages; one wa s due to gastritis related to hepatorenal insufficiency and was fatal. Two other deaths were due to respiratory failure and ascites associated with he patic insufficiency. In one patient after liver transplantation with cluste r resection, a biliary leak and ileocolic fistula were the cause of postope rative mortality. Another patient suffered a ruptured mycotic aneurysm afte r pretransplant transtumoral intubation, which emphasizes the risk of infec tion in an immunosuppressed patient. The main late complication was cholang itis (8 cases). This complication is most often a symptom of recurrence (fo ur cases). Some are due to benign causes (intrahepatic lithiasis, intrahepa tic foreign body granuloma). Surgical exploration is mandatory to exclude b enign complications, which can then be treated palliatively. Four patients presented with recurrence but without cholangitis. In conclusion, the cause s of complications after resection of high bile duct cancer should be caref ully assessed to choose the correct treatment. Late cholangitis is a sympto m of recurrence, but it should be explored and managed precisely.