[A survey on the diagnosis and treatment of biliary tract cancers in Shanghai].
OBJECTIVE
To survey the status of diagnosis and treatment of biliary tract cancer in Shanghai.


METHODS
A clinical epidemiology investigation was carried out on 658 new cases of biliary duct cancers aged 35-74, that registered between June 1997 and May 2001 in urban Shanghai. Clinical findings were collected in 390 gallbladder cancer, 195 bile duct cancer and 73 ampullary cancer.


RESULTS
Biliary tract cancers mainly occurred in elderly patients. Ratio of males to female was 1:2.61 in gallbladder cancer, while bile duct cancer and ampullary cancer were slightly more common in men. Association with gallstones was 68.5%, 43.1% and 22.4% for gallbladder cancer, bile duct cancer and ampullary cancer, respectively. Diagnostic accuracy rate of B-ultrasonography was 63.1% in gallbladder cancer. Incidental gallbladder cancer accounted for 20%, while stage IVA and IVB patients reached up to 43.6%. Misdiagnosis rate was still high in bile duct cancer and ampullary cancer, it was 19.1% and 47.1% respectively. In addition, most patients presented jaundice at diagnosis. 69 cases (18.2%) of gallbladder cancer, 50 cases (25.6%) of bile duct cancer and 54 cases (74%) of ampullary cancer underwent radical resection, the 1-, 3- and 5-year survival rates were 58.5%, 42.8% and 40.7%, 58%, 28.3% and 11.1%, 81.5%, 39.2% and 26.9%, respectively. 79 patients with bile duct cancer underwent palliative drainage, and most cases died within 1 year. Metal endo-prostheses or plastic stents were placed into the biliary tract in 38 patients. The median survival was about 7 months.


CONCLUSIONS
It is difficult to make early diagnosis of biliary tract cancers. Standardization of the operation for gallbladder cancer must be respected. Surgical exploration should be undertaken when a bile duct cancer is suspected and there are no contraindications to surgery. Pancreatoduodenectomy should be recommended for ampullary cancer.
Wang
Bing-sheng
BS
Department of Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. wangbs@zshospital.net
Qin
Jing
J
Deng
Jie
J
Zhang
Bo-he
BH
Han
Tian-quan
TQ
Shen
Ming-chang
MC
Rashid
Asif
A
Hsing
Ann W
AW
Gao
Yu-tang
YT
D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D002681:China / Q000453:epidemiology; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D015996:Survival Rate