eMedicine Specialties > General Surgery > Abdomen

Bile Duct Tumors: Follow-up

Author: Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Coauthor(s): Brian Reed, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center; LaMar O Mack, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center; Ravi Pokala Kiran, MBBS, MS, FRCS (Eng), FRCS (Glas), Staff Physician, Department of General Surgery, St Mary's Hospital; Naveen Pokala, MBBS, MS, FRCS, Staff Physician, Department of Surgery, Bronx Lebanon Hospital
Contributor Information and Disclosures

Updated: Mar 13, 2009

Outcome and Prognosis

In patients with bile duct tumors, the choice of treatment and the prognosis are influenced greatly by the location of the tumor. Prognosis is better for distal bile duct tumors, histologically differentiated, and polypoidal tumors. Factors that suggest poor prognosis include involvement of lymph nodes, vascular invasion, advanced T stage, positive tumor margins of the resected specimen, and the presence of mutations of P53 gene.5

With hilar cholangiocarcinoma, the overall resection rate in most series varies form 40-60%. The mean survival rate for patients undergoing curative resection is 67-80% at 1 year and 11-21% at 5 years. Local resection has a lower operative mortality rate (8%) than does major hepatic resection (15%), with a mean survival of 21 months compared with 24 months for major hepatic resection. No clear indication exists that survival is improved significantly by major hepatic resection when compared with local bile duct resection, though some studies suggest that hepatic resection is associated with a greater incidence of tumor-free margins and, consequently, survival.

In distal bile duct cancers, the resection rate is more than 60%, and the prognosis is better than for hilar tumors, the mean survival being 39 months. The survival rate varies from 50-70% at 1 year to 17-39% at 3 years.

Diffuse intrahepatic tumors have a dismal prognosis; most patients with these tumors die within 1 year of diagnosis.

If left untreated, 50% of patients with bile duct cancer may survive for 1 year, 20% may survive for 2 years, and 10% may survive for 3 years.

Future and Controversies

The role of adjuvant radiotherapy and chemotherapy is controversial.16,17,18 The use of hormones in treatment, including somatostatin analogs, cholecystokinin, and cholecystokinin antagonists, is being investigated.

It has been suggested that preoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage in patients with tumors of the bile duct increases the risk of implantation metastases after resection of the tumor.21 Therefore, preoperative radiotherapy is advocated in such patients, but the benefit has not been definitely proven.22

Transarterial chemoembolization (TACE), infusion of 5-fluorouracil into the hepatic artery or bile ducts, and percutaneous injection of ethanol (PEI) into the lesions are other modalities that are investigational.

Photodynamic therapy may be useful in relieving obstruction, especially when obstruction occurs as a result of tumor outgrowth into an endoprosthesis.23

Liver transplantation, when performed for cholangiocarcinoma, is associated with poor survival.24

 
Acknowledgments

The editors wish to thank Carol E H Scott-Conner, MD, PhD, Professor, Department of Surgery, University of Iowa College of Medicine, for her previous contributions to this article.

The editors also wish to thank Richard E Glass, MBBS, MS, FRCS, Consultant General and Gastrointestinal Surgeon, Department of Gastrointestinal and General Surgery, Princess Margaret Hospital, UK, for his previous contributions to this article.



More on Bile Duct Tumors

Overview: Bile Duct Tumors
Workup: Bile Duct Tumors
Treatment: Bile Duct Tumors
Follow-up: Bile Duct Tumors
Multimedia: Bile Duct Tumors
References
Further Reading
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Keywords

bile duct tumors, bile, bile duct, liver, pancreas, pancreatic, gall bladder, gallbladder, biliary, hepatic, cholecystectomy, cholangiocarcinoma, bile duct cancer, liver bile, biliary tree, biliary duct, biliary disease, gall bladder disease, gallbladder disease, gall bladder cancer, gallbladder cancer, bile duct symptoms, bile ducts, Klatskin tumor, cholangiocarcinoma of the hepatic duct bifurcation

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Contributor Information and Disclosures

Author

Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Todd A Nickloes, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Brian Reed, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center
Brian Reed, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

LaMar O Mack, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center
LaMar O Mack, MD is a member of the following medical societies: American Urological Association, National Medical Association, and Student National Medical Association
Disclosure: Nothing to disclose.

Ravi Pokala Kiran, MBBS, MS, FRCS (Eng), FRCS (Glas), Staff Physician, Department of General Surgery, St Mary's Hospital
Disclosure: Nothing to disclose.

Naveen Pokala, MBBS, MS, FRCS, Staff Physician, Department of Surgery, Bronx Lebanon Hospital
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

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