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.
Accuracy of computerized tomography in determining hepatic tumor size in patients receiving liver transplantation or resection.
