Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract.

Seven patients with advanced carcinoma of the extrahepatic biliary tract, including two with cancer of the gallbladder, underwent major hepatectomy with concomitant pancreatoduodenectomy. The mean hepatic volume resected was 64 (range 35-81) per cent. Postoperative complications occurred in all patients and accounted for two hospital deaths. Two patients with gallbladder carcinoma survived without recurrence for 22 and 58 months. Three of five patients with bile duct cancer survived operation, although all three subsequently died from recurrent disease at 8, 10 and 27 months. Combined major hepatectomy and pancreatoduodenectomy may be appropriate in selected patients with advanced cancer of the gallbladder. Further evaluation is necessary before this approach can be recommended for those with advanced bile duct carcinoma.