Resection and bypass for malignant obstruction of the bile duct.

Ninety-one patients with malignant biliary obstruction, excluding carcinoma of the head of the pancreas and periampullary cancer, are analyzed. Sixty-five patients had hilar tumors, 32 Klatskin tumors, and 33 malignant hilar biliary obstructions due to primary carcinoma of the gallbladder or metastatic spread to the hilum from other primary sites (pseudo-Klatskin tumors). There were 9 patients with carcinoma of the middle third and 16 patients with carcinoma of the lower third of the bile duct. Resection rates were 31% (10 of 32) for Klatskin tumors, 3% (1 of 33) for pseudo-Klatskin tumors, 22% (2 of 9) for carcinomas of the middle third, and 88% (14 of 16) for carcinomas of the lower third of the bile duct. Jaundice was completely relieved in all patients undergoing resection. Three patients are alive 2 months, 8 years, and 7 years, respectively, after resection of Klatskin tumors and 5 of the 16 patients with resection of lower third carcinomas are alive 8 months to 9 years after operation, respectively. Surgical bypass by the Hepp or Soupault approaches to the left duct or to the duct of segment V of the right lobe was used in 47% of patients with Klatskin tumors and 58% of patients with pseudo-Klatskin tumours. Median survival times were 6 months and 4 months, respectively, in these two groups. Surgical bypass was used in 67% of patients with carcinoma of the middle third and 13% of patients with carcinoma of the lower third of the bile duct. Median survival time was 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)