12. Tumors of the biliary tract (bile duct and gallblader)

Question 1

Unresectable tumors

Answer 1

50% are unresectable at time of diagnosis

6 months median survival if unresectable

Question 2

Surgical resection T1

Answer 2

T1 (limited to muscular layer of GB) – simple cholecystectomy

Question 3

T2

Answer 3

T2 (invades perimuscular CT) – radical cholecystectomy (wedge resection of hepatic bed or a segment of 4b and 5 with lymphadenectomy)

Question 4

T3

Answer 4

T3 (perforates serosa, invades liver or other structure) – segment 4b and 5 resection or extended right hepatectomy

Question 5

T4

Answer 5

T4 (invades portal vein, hepatic artery or multiple extrahepatic organs) – radical liver excision (e.g. Right hepatectomy)

Question 6

Choleangiocarcinomas classification

Answer 6

• Intrahepatic
• Peri-hilar (Klatskin) – 70% of cases
• Distal

Question 7

Principles of surgical treatment

Answer 7

• Surgical treatement: surgical exploration to assess
  resectability, staging laparoscopy, hilar 🡨 unresectable
• 5 year survival after resection is 10-30%, but improves
  survival and quality of life