Biliary Flashcards
1
Q
What does a radical cholecystectomy involve?
A
Removal of gallbladder, nodal dissection and possible excision of adjacent liver tissue.
2
Q
What surgery is performed for tumours of the bile duct?
A
Hepaticojejunostomy if below first division of left or right main duct.
3
Q
What percentage of cholangiocarcinomas are intrahepatic?
A
20%
4
Q
What investigations should be performed for suspected biliary cancer?
A
FBC, renal & liver profile, CA 19-9 USS CT TAP ERCP or PTC (better for proximal tumours) incl biopsy EUS Laparoscopy (r/o peritoneal mets) MRCP (non invasive but no biopsy) PET-CT considered
5
Q
How many tumours are resectable at diagnosis?
A
<20%
6
Q
What is the optimal treatment for a resectable biliary cancer?
A
Resection followed by adjuvant capecitabine 1250mg/m2 BD D1-14 Q21d x8
mOS 53m
7
Q
What is first line chemotherapy in inoperable/metastatic pts?
A
Cisplatin 25mg/m2 D1 & D8
Gemcitabine 1000mg/m2 D1 & D8
Q21d x 8 cycles
mOS 11.7m
SA gem if unfit
