Intrinsic involvement of bile ducts, by metastaticcolorectal adenocarcinoma growing from within orinvading the lumen of bile ducts, is not a wellrecognized pattern of tumor growth. Clinical, radiographic,operative, and histopathologic aspects of 15patients with intrabiliary colorectal metastases weredescribed. Fourteen patients were explored forpossible hepatic resection. Two had jaundice, tworadiographic evidence of an intrabiliary fillingdefect, 10 intraoperative evidence of intrabiliarytumor, and six microscopic evidence of intrabiliariytumor. Eleven patients underwent hepatic resection.Five of the resected patients developed hepaticrecurrence. Four patients were explored for possiblerepeat resection. One had jaundice, one radiographicevidence of an intrabiliary filling defect, all hadintraoperative evidence of intrabiliary tumor, andthree microscopic evidence of intrabiliary tumor.Three patients underwent repeat hepatic resection.All patients with preoperative jaundice and radiographicevidence of an intrabiliary filling defectwere unresectable. Overall, actuarial five-year survivalis 33% for those patients resected versus 0% forthose not resected. Intraoperative recognition ofintrabiliary tumor at exploration for hepatic resectionwas more common than clinical, radiographic,or histopathologic recognition. More diligent examinationof resected liver tissue by the surgeon andpathologist may increase identification of bile ductinvolvement and aid in achieving adequate tumorclearance.
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