The management of proximal biliary tract tumors.

Although a relatively unusual tumor, carcinoma of the proximal biliary tree merits inclusion in the differential diagnosis of all cases of obstructive jaundice. A confident preoperative diagnosis is possible, in the majority of cases, with percutaneous transhepatic cholangiography. The improved accuracy of diagnosis of the tumor has indicated that the incidence is higher than hitherto suspected. Early diagnosis and careful evaluation and selection of cases both preoperatively and intraoperatively should improve overall resectability rates as well as survival. In the past, the overall results of treatment of bile duct cancer were unsatisfactory, with the majority of patients dead within one year of liver failure and sepsis. Now, however, as well as possible cures, extended periods of effective palliation can be provided by current techniques. Transhepatic Silastic biliary stents and U tubes provide lasting palliation. New techniques in radiotherapy allow delivery of massive doses of radiation locally to the tumor site. The results of the transhepatic intubation procedures with or without curative resection, combined with radiotherapy, are encouraging and merit continued evaluation. Chemotherapy treatment using currently available regimens appears to offer very little benefit to these patients.