EKSTRAHEPATIC BILE DUCT CANCER
Background. Malignant strictures involving the bile ducts remain a major challenge in biliary surgery. It is an uncommon cancer. The etiology is unknown, most cases are sporadic, but several conditions confer an incrised risk of developing cholangiocarcinoma.
Clinical presentation and preoperative evaluation. The early simptoms are nonspecific. In the past computed tomography, percutaneous transhepatic cholangiography and angiography were considered standard investigations, but currently magnetic resonance cholangiopancreatography is providing the same information with less risk. Evaluation of patients is principally an assessment of resectability since resection is the only effective therapy. BismuthCorlette classification and determinants of resectability are presented.
Treatment. Different kinds of resections are used, according to the type of tumor based on Bismuth-Corlette classification. If resection is not possible, intrahepatic biliary-enteric bypass or percutaneous biliary drainage are performed. Currently there is no role for adjuvant radiochemotherapy.
Conclusions. The treatment of hilar cholangiocarcinoma continues to evolve. Jucidious use of preoperative investigations and improvements in surgical tehnique has allowed better patient selection and performance of appropriately radical operations with an acceptable mortality.
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