Gross appearance of carcinoma of the main hepatic duct and its prognosis.

Twenty-three patients with carcinoma of the hepatic hilus, including the upper one-third of the extrahepatic bile duct, were treated by surgical resections. Gross appearances of this lesion are classified into polypoid, nodular, schirrhous constricting and diffusely infiltrating types. Each type has a different resectability and prognosis from the macroscopic point of view. The cell type in all patients was adenocarcinoma. Operation was curative in 100 per cent of four patients with the polypoid type. The chance for survival was definitively better for patients with this type than with the other three. Preoperative percutaneous transhepatic cholangiography as well as endoscopic retrograde cholangiography and celiac angiography can provide an excellent index to the resectability of the tumor and prognosis. Our experience suggests that gross appearance of the tumor may be valid as a prognostic factor in the treatment of the lesion.