In a minority of cases, proximal bile duct cancer can be completely resected. Cures are not often achieved in these patients, in contrast to patients with tumors arising in the distal bile duct, for whom a 5-year survival may be achieved in as many as 25% of patients.
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Surgery. The optimum surgical procedure for carcinoma of the extrahepatic bile duct will vary according to its location along the biliary tree, the extent of hepatic parenchymal involvement, and the proximity of the tumor to major blood vessels in this region. The state of the regional lymph nodes must be assessed at the time of surgery because proven nodal involvement may preclude potentially curative resection. Operations for bile duct cancer are usually extensive and have a high operative mortality (5%–10%) and low curability. Cases with cancer of the lower end of the duct and regional lymph node involvement may warrant an extensive resection (Whipple procedure), but bypass operations or endoluminal stents are alternatives if lymph nodes are clinically involved by the cancer.
In jaundiced patients, percutaneous transhepatic catheter drainage or endoscopic placement of a stent for relief of biliary obstruction should be considered before surgery, particularly if jaundice is severe or an element of azotemia is present. An understanding of both the normal and varied vascular and ductal anatomy of the porta hepatis has increased the number of hepatic duct bifurcation tumors (Klatskin tumors) that can be resected.[1,2,3]
External-beam radiation (EBRT). EBRT has been used in conjunction with surgical resection.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized extrahepatic bile duct cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Shutze WP, Sack J, Aldrete JS: Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988. Cancer 66 (8): 1717-20, 1990.
Bismuth H, Nakache R, Diamond T: Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215 (1): 31-8, 1992.
Pinson CW, Rossi RL: Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer. World J Surg 12 (1): 52-9, 1988.
Cameron JL, Pitt HA, Zinner MJ, et al.: Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 159 (1): 91-7; discussion 97-8, 1990.
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September 04, 2014
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