AIM: To analyze the diagnostic and therapeutic features of extrahepatic bile duct carcinoma (EBDC) without jaundice.METHODS: Between 1985 and 1999, 101 patients underwent surgery for EBDC in Xiangya Hospital. These patients were divided into two groups: 84 jaundiced patients and 17 nonjaundiced patients according to preoperative serum total bilirubin levels. The clinical manifestations, laboratory findings,location, pathology and surgical resectability of the tumors were compared between the two groups.RESULTS: The laboratory parameters such as hemoglobin,serum albumin ALB, AKP, γ-GT, and sonography appearance were similar between the two groups, and there was no significant difference in tumor location, pathological type and resectability. However, the number of non-jaundiced patients associated with chololithiasis was significantly greater than that of jaundiced patients (P = 0.008).CONCLUSION: The presence of jaundice is not a reliable criterion for the prediction of the resectability and the extent of tumor progression in extrahepatic bile duct carcinoma.Decreased levels of blood hemoglobin and serum albumin,elevated levels of AKP and γ-GT, and/or abnormal sonography may be suggestive. Biopsy of a stenotic or thickened bile duct is strongly recommended for a correct diagnosis before the appearance of jaundice.