Operations for Carcinoma of Hepatic Duct Bifurcation

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 et al. 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 et al. 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.