Surgery for cholangiocarcinoma
The incidence of cholangiocarcinoma, cancer of the bile duct, has steadily increased over the years. Patients commonly present with jaundice as a result of biliary obstruction.
A close collaboration with our interventional radiologists is essential, as percutaneous biliary drainage is necessary to decompress the biliary tract, to prevent cholangitis and to facilitate liver regeneration after surgery. With this approach, biopsy and direct visualisation of the tumour with cholangioscopy is also feasible.
Cholangiocarcinoma and gall bladder cancer are traditionally poorly responsive to chemotherapy and extensive hepatic resections are frequently required to eradicate the disease. Vascular resection and reconstruction are also required in cases with locally advanced tumours.
In patients with inoperable disease, palliation is achieved by deploying mesh metal stents in the biliary tree by the interventional radiologists to ensure adequate bile flow and resolution of the jaundice. Chemotherapy, alone or in combination with photodynamic therapy (PDT), is available to palliate these patients. With PDT, a photosensitising drug is injected intravenously and is subsequently activated by laser light applied directly to the tumour with a small probe deployed endoscopically or percutaneously.