Surgical management of carcinoma of the junction of the main hepatic ducts.

Twenty-six patients are reviewed who had primary carcinomas involving the junction of the hepatic ducts. The majority had had an initial procedure of palliative biliary diversion elsewhere and were referred for further treatment. In three cases, en bloc resection of the tumor with total hepatectomy and orthotopic liver transplantation were performed. All tumor growth was encompassed in each case, but within 4 months all succumbed as a result of allograft rejection. Auxiliary (heterotopic) liver transplantation was performed in another patient because of recurrent disease after previous left hepatic resection in continuity with a hilar duct lesion. Five patients underwent hepatic lobectomy with en bloc resection of the hepatic duct junction. When adequate tumor excision was not feasible, biliary diversion could provide good palliation in some instances for extended periods of time. This is demonstrated by one patient who lived for 4 years and 4 months after the initial operation. In the meantime, the patient underwent 6 subsequent procedures of dilating of constricted bile ducts and tube cannulation of the biliary tree. Biliary diversion was achieved in 4 cases by intrahepatic cholangiojejunostomy. One of these patients, who is on chemotherapy, is asymptomatic one year after surgery.