Operations for Carcinoma of Hepatic Duct Bifurcation

  • Jameson L. Chassin

Abstract

For purposes of classification the bile ducts are generally divided into thirds. The proximal third extends from the cystic duct upward. The middle third starts at the cystic duct and includes that portion of the common bile duct (CBD) that is located cephalad to the pancreas. The distal third encompasses the CBD in its course between the pancreas and duodenum, ending at its termination in the ampulla of Vater. Operation for cure in the region of the distal third of the bile duct requires a Whipple pancreatoduodenectomy. Whereas Lees, Zapolanski, Cooperman, and Hermann of the Cleveland Clinic were able to resect only 19% of 32 patients having carcinoma of the distal third of the duct, Tompkins, Thomas, Wile, and Longmire performed the Whipple operation in 12 of their 18 cases with a mortality rate of 8%. Forty-two percent of the cases resected by Tompkins and associates survived for 5 years. There seems little question that pancreatoduodenectomy is the treatment of choice for lesions of the distal CBD.

Keywords

Catheter Sludge Rubber Flare Gall 

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References

  1. Adson MA, Farnell MB (1981) Hepatobiliary cancer—surgical consideration. Mayo Clin Proc 56: 686PubMedGoogle Scholar
  2. Cameron JL, Broe P, Zuidema GD (1982) Proximal bile duct tumors: surgical management with Silastic transhepatic biliary stents. Ann Surg 196: 412PubMedCrossRefGoogle Scholar
  3. Cameron JL, Gayler BW, Zuidema GD (1978) The use of Silastic transhepatic stents in benign and malignant biliary strictures. Ann Surg 188: 552PubMedCrossRefGoogle Scholar
  4. Hart MJ, White TT (1980) Central hepatic resections and anastomosis for stricture or carcinoma at the hepatic bifurcation. Ann Surg 192: 299PubMedCrossRefGoogle Scholar
  5. Lees CD, Zapolanski A, Cooperman AM, Hermann RE (1980) Carcinoma of the bile ducts. Surg Gynecol Obstet 151: 193PubMedGoogle Scholar
  6. Tartarchuk JW, White TT (1979) A new instrument for inserting a U-Tube. Am J Surg 137: 425CrossRefGoogle Scholar
  7. Terblanche J, Saunders SJ, Louw JH (1972) Prolonged palliation in carcinoma of the main hepatic duct junction. Surgery 71: 720PubMedGoogle Scholar
  8. Tompkins RK, Thomas D, Wile A, Long-mire WP Jr (1981) Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg 194: 447PubMedCrossRefGoogle Scholar
  9. Voyles CR, Bowley NJ, Allison DJ, Benjamin IS et al. (1983) Carcinoma of the proximal extrahepatic biliary tree; radiologic assessment and therapeutic alternatives. Ann Surg 197: 188PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.New York University School of MedicineUSA
  2. 2.Booth Memorial Medical CenterFlushingUSA
  3. 3.University Hospital, New York University Medical CenterUSA
  4. 4.New York Veterans Administration HospitalUSA
  5. 5.Bellevue HospitalUSA

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