Results of treatment of extrahepatic cholangiocarcinoma at Kaunas University of Medicine Hospital.

Adenocarcinoma of the extrahepatic bile ducts is considered to be a rare cause of obstructive jaundice. Prognosis is poor and only radical surgery can prolong the life of such patients. The aim of study was to evaluate the outcome of treatment of patients having extrahepatic carcinoma of the bile ducts. Patients underwent treatment at Kaunas University of Medicine Hospital. A retrospective study was performed of 57 patients suffering from cancer of extrahepatic bile ducts in 1996-2001. Diagnosis was established by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. Sixteen patients (25%) received symptomatic treatment. Thirty-three patients (61%), receiving palliative therapy, underwent a biliodigestive bypass (n=14), an intraoperative biliary stenting (n=10), an endoscopic biliary drainage (n=6), or percutaneous transhepatic biliary drainage (n=3). Eight patients (14%) underwent radical resections of bile ducts: five patients had resections of bile ducts with D2 lymphonodectomy, two patients had bile duct resections in combination with pancreatoduodenal resection and one patient had resection of the bile ducts in combination with right hepatectomy. Histological examinations of the resected specimens revealed a curative effect in seven out of eight cases. There were no deaths in the group of radically treated patients. In the group of patients receiving palliative therapy 8 patients died: four patients died because of cardiovascular complications, two patients died of hepatorenal syndromes, one patient died because of multiorgan failure and one died of peritonitis. Five patients died in the group receiving symptomatic treatment. Assessing remote results of treatment, median survival time of patients who underwent resection was 89 days. Survival results of patients who had curative resections were much better (ranging from 277 to 1084 days). Median survival time of patients, receiving palliative treatment, was 65 days and 29 days of group, receiving symptomatic treatment. Recent progress made in surgical techniques and in perioperative management of extrahepatic cholangiocarcinomas as well as modern diagnostic achievements has greatly contributed to the outcomes of radical surgery. The main aim of the treatment is to perform resection of the bile ducts cancer.