Abstract
Stenosing tumours of the terminal common bile duct are included amongst those neoplasms with the worst prognosis. Due to limitations of radical surgical therapy, along with a relatively short period of survival, some authors base consequently rejected surgical therapy in favour of palliative endoscopic drainage of the bile ducts.
Materials and Methods: (Between 1995 and 2003), surgery was performed in our clinic of 129 patients for stenosing tumours of the common bile duct. We evaluated tumour histology, perioperative mortality, morbidity after both radical and palliative surgery, as well as long term results of therapy assessed using median time of survival for the individual tumour types.
Recurrence of common bile duct obstruction postoperatively was also evaluated. Results: Ductal adenocarcinoma of the pancreas was the cause of terminal bile duct obstruction in the majority of cases.
Different tumour histology was found however in more than 40% of the tumours that were able to be resected. A 5% mortality rate within 30 days was found; the morbidity rate was 19%.
The median rate of survival after radical surgery was 17.5 months, as compared with 5.5 months in patients following palliative procedures. Obstructive jaundice recurred in 3% of patients.
Conclusion: In comparing our results with those after published endoscopic palliative measures, it is evidence that both procedures are comparably effective in palliative treatment of the bile duct tumours, providing correct indication. Surgery is furthermore preferred in potentially resectable tumours, and in younger patients with perspective of longer survival.