Clinical Problems of Surgical Treatment for Carcinoma of the Bile Duct, with Special Interest to the Pathological and Molecular Biological Features and Mode of Tumor Recurrence.

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The pathological and molecular biological features and mode of tumor recurrence in carcinoma of the bile duct were studied in 64 cases of curative and relative non-curative resection. The state of ew<SUB>0</SUB> could be obtained in some cases of carcinoma of the middle or lower bile duct, even in cancer invasion of the serosa (se) or beyond the serosa (si). However, in advanced carcinoma of the hepatic duct or upper bile duct, ew<SUB>0</SUB> was achieved in only 1 patient with cancer involvement restricted to the subserosal layer (ss). In about 40% of the patients, extramural tumor extension through microvascular and/or perineural invasion was found on the hepatic side margin of the tumor. Thus, it is difficultin carcinoma of the hepatic duct or upper bile duct to obtain sufficient cancer free margin in the hepatic side even if hepatic resection is employed. After relative non-curative resection, local recurrence within 3 years was frequent, and in patients with early recurrence, the incidence of aneuploid and/or tensacin-positive tumors was significantly higher than in those with long-term survival. Even after curative resection, late recurrence was occasionaly experienced, especially in the cases with extramural tumor extension.
一般社団法人日本消化器外科学会の論文