Surgical resection of distal common bile duct carcinoma

Adenocarcinoma of the extrahepatic bile ducts is a relatively rare malignant neoplasm. Despite the recent progress of diagnostic and therapeutic modalities, the prognosis for patients with middle and distal bile duct carcinoma remains poor. Even in recent reports, the 5-year survival rate after resection of the middle-distal bile duct carcinoma is still not satisfactory (at around 35%) [1-7]. On the other hand, although the recent several phase II trials of chemotherapy for biliary carcinoma with novel agents, such as the combination of gemcitabine and capecitabine [8], capecitabine and cisplatin [9], and gemcitabine and oxaliplatin [10], show both improvements in response rates in the range of 21-33% and prolonged median survivals in the range of 9.1-15.4 months when compared with older series, these results are still far from satisfactory. Despite the poor prognosis, surgical resection remains the only potentially curative treatment for bile duct carcinoma. We describe herein the surgical treatment and outcome of distal common bile duct carcinoma.