[Criteria for the resectability of malignant extrahepatic bile duct tumours]
S Kissenkoetter1, H Witzigmann
1Krankenhaus Dresden-Friedrichstadt, Klinik für Allgemein- und Viszeralchirurgie, Dresden, Deutschland. kissenkoetter-st@khdf.de
Background:
Most cholangiocarcinomas of the extrahepatic bile duct are diagnosed at an advanced stage. Surgery represents the only potentially curative treatment. An assessment as to whether a curative resection is possible is based on the experience of the treating physicians.
Methods:
The present guidelines are based on comprehensive literature surveys in PubMed, including results from randomised controlled trials, systematic reviews and meta-analyses, and cohort studies.
Results:
The experience of the surgeon is determining for defining criteria for resection. The surgical standards for treating Klatskin tumours are extended liver resections. Liver transplantation after neoadjuvante chemo / radiation therapy offers good results. N1 regional lymph node metastases are not a contraindication for resection. R1 resection is justified as a very efficient palliative procedure. The surgical standard for treating distal cholangiocarcinoma is the partial pancreatoduodenectomy. Infiltration of the mesenterico-portal veins or regional lymph nodes is not a contraindication for resection. However, resection has not been shown to provide survival benefit if the coeliac trunk or the superior mesenteric artery is infiltrated. There is no evidence for or against a palliative R1/R2 resection.
Conclusions:
For anatomic reasons, the resection rates for distal cholangiocarcinoma are higher than those for Klatkin tumours. The decision as to whether or not a curative resection is possible, especially for Klatskin tumour, requires detailed preoperatzive diagnostics and a conditioning of the patient.
