Surgical treatment for carcinoma at the confluence of the major hepatic ducts.

During the period of November 1976 through October 1984, we have treated 46 patients with carcinoma at the confluence of the major hepatic ducts. Curative resection of the tumor (where no carcinoma cells at the margin of the resected portion were found macroscopically and microscopially), was performed upon ten patients, palliative resections were done in 11, palliative resection and intraoperative radiotherapy (IOR) in ten, bile duct drainage and IOR in three, and percutaneous transhepatic cholangiodrainage in 12. Among the ten patients who underwent curative operation, five are living six to 104 months after operation while the remaining five died four to 72 months postoperatively. Of the 11 patients who underwent palliative resection, five are alive two to 22 months after operation and six died between four and 20 months after operation. For the ten patients with carcinoma in the advanced stages, palliative resection with IOR was performed. Eight patients died 20 days to 16 months after operation while two patients are alive 13 and 14 months after the procedure. Of the three patients who underwent drainage of the bile duct and IOR, two died three months after operation and one patient survived 34 months. Twelve patients underwent drainage of the bile duct only and all died after 13 months. To perform a curative operation for carcinoma located at the confluence of major hepatic ducts, it is necessary to resect the right or left lobe, including the caudate lobe, in many instances. For the patients with carcinoma in the advanced stages, the possibility of long term survival period after operation exists through the use of the combined techniques of IOR and palliative resection of the tumor.