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HPB Surgery
Volume 11 (2000), Issue 6, Pages 383-391
http://dx.doi.org/10.1155/2000/17619

Recognition of Intrabiliary Hepatic Metastases From Colorectal Adenocarcinoma

1Department of Surgery, Memorial Sloan – Kettering Cancer Center, New York, New York, USA
2Department of Pathology, Memorial Sloan – Kettering Cancer Center, New York, New York, USA
3Department of Radiology, Memorial Sloan – Kettering Cancer Center, New York, New York, USA
4Department of Medicine, Memorial Sloan – Kettering Cancer Center, New York, New York, USA
5Section of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
6Department of Surgery, Memorial Sloan – Kettering Cancer Center, 1275 York Avenue, New York 10021, New York, USA

Received 16 May 1999; Accepted 25 October 1999

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intrinsic involvement of bile ducts, by metastatic colorectal adenocarcinoma growing from within or invading the lumen of bile ducts, is not a well recognized pattern of tumor growth. Clinical, radiographic, operative, and histopathologic aspects of 15 patients with intrabiliary colorectal metastases were described. Fourteen patients were explored for possible hepatic resection. Two had jaundice, two radiographic evidence of an intrabiliary filling defect, 10 intraoperative evidence of intrabiliary tumor, and six microscopic evidence of intrabiliariy tumor. Eleven patients underwent hepatic resection. Five of the resected patients developed hepatic recurrence. Four patients were explored for possible repeat resection. One had jaundice, one radiographic evidence of an intrabiliary filling defect, all had intraoperative evidence of intrabiliary tumor, and three microscopic evidence of intrabiliary tumor. Three patients underwent repeat hepatic resection. All patients with preoperative jaundice and radiographic evidence of an intrabiliary filling defect were unresectable. Overall, actuarial five-year survival is 33% for those patients resected versus 0% for those not resected. Intraoperative recognition of intrabiliary tumor at exploration for hepatic resection was more common than clinical, radiographic, or histopathologic recognition. More diligent examination of resected liver tissue by the surgeon and pathologist may increase identification of bile duct involvement and aid in achieving adequate tumor clearance.