Cholangiocarcinoma Surgery

Daniel Catenacci MD

January 4, 2023

If you have been diagnosed with cholangiocarcinoma, it’s a good idea to know what surgeries are done to treat this condition. There are two main types of surgeries for this condition, which are Hepatic resection and palliative surgery. Both of these surgeries can be performed either to remove cancer from the liver or to relieve symptoms caused by the disease.

Symptoms of cholangiocarcinoma

The symptoms of cholangiocarcinoma include fever, abdominal pain, and jaundice. These cancers affect the hepatobiliary system, which consists of the liver and gallbladder. If your doctor suspects that you have this condition, there are several treatments available.

Cholangiocarcinoma is a rare form of cancer that develops in the bile ducts, which connect the liver to the gallbladder. These ducts carry bile, which helps the body break down fats and waste. There are two types of bile duct cancer, intrahepatic and extrahepatic.

Intrahepatic cholangiocarcinoma occurs in a small portion of the bile ducts inside the liver. Extrahepatic cholangiocarcinoma, on the other hand, develops in the bile ducts outside of the liver. Both forms can cause similar symptoms.

The most common symptom of cholangiocarcinoma is jaundice. Bilirubin, a waste product from the liver, accumulates in the blood and causes yellowing of the skin and eyes. This condition can also lead to itching and fatigue.

Another symptom of cholangiocarcinoma that can occur is clonorchiasis, an infection with the Chinese liver fluke parasite. Some people with this parasite develop a bile duct cyst, which can become precancerous. In some cases, bile duct stones may also occur.

The most severe symptom of cholangiocarcinoma, however, is cancer spread. Fortunately, most bile duct cancers can be treated with surgery. However, some patients need chemotherapy after surgery, and others may require radiation treatment.

Hepatic resection

Hepatic resection for cholangiocarcinoma is associated with considerable morbidity. However, with advances in anesthetic techniques and postoperative care, mortality rates have significantly decreased. Surgical resection is the only way to cure this lethal disease.

The current study aims to determine which factors are predictive of survival after resection of HC. This is done by analyzing patients that underwent surgical resection at Mansoura University, Egypt. All pathological reports were reviewed to evaluate the extent and nature of the tumor and lymph node metastasis. Survivors were divided into two groups according to their overall survival.

The authors found that five-year survival was higher in patients who underwent significant hepatic resection than those who underwent less extensive resections. Furthermore, the younger age of survivors was associated with more prolonged survival.

Another factor that is associated with long-term survival is the number of positive safety margins. These margins are found at the edge of the bile duct. Negative surgical margins can increase the risk of postoperative complications. Consequently, a negative surgical margin has an essential impact on the long-term survival of patients with HC.

A third variable that is associated with more prolonged survival is the presence of a well-differentiated HC tumor. In this study, the Bismuth-Corlette classification system was used to determine the extent of a tumor. When the cancer was classified as well differentiated, the 5-year survival rate was more than 60%.

Palliative surgery

Cholangiocarcinoma is a rare malignant tumor that arises from the epithelial cells of the bile duct system. It is often diagnosed with persistent abdominal pain or jaundice. Chemotherapy is an essential part of cholangiocarcinoma treatment. In advanced cases, chemotherapy may be used before a liver transplant is performed.

There are two types of cholangiocarcinoma. The extrahepatic type occurs in bile ducts outside of the liver, while the intrahepatic type occurs in bile canals inside of the liver. Each location has a different natural history.

Several studies have shown that palliative surgery can provide significant symptom relief to a large proportion of patients. However, determining the long-term outcome of such surgery remains challenging.

This article presents a systematic review of a number of prospective and retrospective studies evaluating the clinical outcomes of palliative surgery in cholangiocarcinoma patients. These studies examined survival rates, postoperative morbidity, and surgical effects of 678 patients who met the criteria for palliative surgery.

Comprehensive literature surveys included results from randomized controlled trials, systematic reviews, and cohort studies. These data were combined and analyzed using a log-rank test to determine overall 3-year survival rates. Results were then categorized by primary lesion location.

Overall, the 5-year survival rate of cholangiocarcinoma patients in the United States is below 20%. While some patients do survive chemotherapy, a significant minority die of recurrence.