In a 20-year period, from 1949 through 1969, a total of 32 cases of carcinoma of the common bile duct were treated on the Surgical Service at Barnes Hospital in St. Louis. Two cases are lost to follow-up. The results of conservative surgery were very poor. Those patients who had a biopsy only died usually within a month following the procedure. The 17 patients treated by T-tube decompression (excluding those who died in the immediate postoperative period) survived an average of 13.5 months (excluding the hospital deaths). The one patient with a definitive resection is still alive, with no evidence of disease 31 months postoperatively. It is our opinion that a more aggressive approach to this disease should be undertaken in view of the poor results that have been obtained with lesser procedures.