A total of 84 cases of primary carcinoma of the bile duct admitted the 13-year period, 1965-1978 to Kyoto University Hospital, are reviewed. A comparison of these cases was made and emphasized with regard to prognostic factors, which were the Infiltrative Factors (I.N.F.) and invasions into Lymphatic Vessels (Ly.), Veins (V.), Pancreas (P.) and Liver (H.).
There were 60 men and 24 women, and the mean age was 59.0 years (35-75 years). Forty-One of the 84 patients (48.8%) were resectable and 19 patients (22.6%) died within one month after operation. We concentrated on 6 different areas;1) intrahepatic region, so-called cholangioma, 2) region of hepatic ducts and common hepatic ducts, 3) confluence of cystic duct, common bile duct and common hepatic ducts, 4) suprapancreatic portion, 5) intrapancreatic portion, 6) papilla of Vater.
The tumor arising near the confluence of the hepatic duct and cholangioma were resected poorly, but other location tumors were resected well, particullarly on the in-trapancreatic portion and the papilla of Vater. The tumor differed in histopathology. The resectability of the tumors did not always correlate with differentiation grading. High resectability of the tumors on the intrapancreatic portion and the papilla of Vater is due to anatomical location surrounding the pancreas and duodenum. Many of the tumors were often scirrhous, so-called I.N.F., γ. Sometimes microscopic invasion into Ly., V., P, and H. may reflect prognostic factors.
On carcinoma of the papilla of Vater, there was no correlation between macroscopic findings and histology. That is, early papillary adenocarcinoma produced a type of tumor formation and advanced papillary adenocarcinoma produced a type of ulcer formation.
Five year survival on carcinoma of the intrapancreatic portion and the papilla of Vater were only present and were 27.3% and 10.5%, respectively.
The longest survival was 10.4 years on carcinoma of the papilla of Vater. To obtain the best prognosis, attention must focus on means of earlier diagnosis and radical en bloc resection with adjuvant therapy.
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