How to improve the outcome of the biliary tract carcinoma infiltrating the hepatic hilum? Investigation of intravascular ultrasography for such patients.

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Hepato-biliary-pancreatic carcinoma has poor prognosis and often invades the major vessels such as the portal vein and the inferior vena cava. Findings of invasion may determine indication of surgery and affect surgical procedure and it related in long-term survival. However, it is difficult to confirm the invasion accurately using ordinal ultrasonography, computed tomography, and angiography. We investigate improvement of both resectability and curability in advanced hepato-biliary-pancreatic tumor by using intravascular ultrasonohraphy. And clinical significance of the procedure was ecaluated compared with findings of operating findings, angiography, resected specimen.Thirty-six patients (5 gallbladder carcinomas, 9 bile duct carcinomas, 10 pancreatic carcinomas, 10 liver tumors and 2 other diseases) underwent endovascular ultrasonography. Intraportal procedure was performed in 31 patients and intracaval procedure was performed in 3 patients who had liver tumor. vascular invasion of the tumor was suspected in 13 patients and was confirmed in three of them by pathologic examination in the excised specimen. Resection was determined using the findings from the procedure.In conclusion endovascular ultrasonography gives accurate information of relationship between the tumor and major veins such as the portal vein and the inferior vena cava. It may be helpful to determine indication of venous resection accompanied to by radical surgery in hepato-biliary-pancreatic surgery and to prolong survival of such patients in the near future.