Surgical Treatment and Prognosis for 268 Patients with Biliary Tract Cancers

ABSTRACT

PURPOSE: Carcinomas of the biliary tract are considerably rare conditions. In spite of recent progress in diagnosis and treatment, resectability remains low, and the prognosis is still discouraging. This review summarizes our 12-year experience with biliary tract cancers, with particular focus on the survival rates after operation and the prognostic factors that affected the survival of patients. METHODS: Between 1987 and 1998, 268 patients with biliary tract cancers were operated on at our institution. The clinical and the pathologic data were collected, and a survival analysis was performed. RESULTS: The tumor was located in the gallbladder in 90 patients, in the proximal bile duct in 74 patients, in the distal bile duct in 54 patients, and in the ampulla of Vater in 50 patients. One hundred ninety-seven patients underwent a radical resection (resection rate 73.5%). A curative resection was achieved in 140 patients (curative resection rate 71.1%). The overall operative mortality after resection was 3.0%. The cumulative survival rates at five years after resection were 61.1% for carcinomas of the gallbladder, 25.8% for proximal bile duct cancers, 28.9% for distal bile duct cancers, and 48.7% for ampulla of Vater cancers. The one-year survival rates for the non-resection group were 18.2% and 26.6% for gallbladder cancers and proximal bile duct cancers, respectively. The mean survival periods for unresectable distal bile duct cancers and ampullary cancers were 4.7 months and 8.3 months, respectively. Positive lymph-node metastasis was a statistically significant, poor prognostic factor. CONCLUSION: Long-term survivals can be expected by a radical surgery for patients with biliary tract cancers. Increasing the resection rate by performing an extended procedure is essential for the improvement of treatment outcomes.