[Surgical treatment of hilus cancers]

Carcinomas of the hilus are malignancies which obstruct the upper part of the bile duct, including the Klatskin tumour but also neighbouring carcinomas invading the hilus and obstructing the biliary tract at this level. The aim of the treatment is to remove the tumour but in our experience, this radical treatment can be accomplished in only 10% of the carcinomas of the hilus. Therefore, the treatment is in the majority of the cases only palliative and the technique the authors used is the intrahepatic cholangio-anastomosis between the duct of Segment III and a Roux-en-Y jejunal loop by the approach of the intrahepatic duct in the Round Ligament fissura. In 61 cases of intrahepatic cholangioanastomoses, performed for the majority according this technique, the mortality was 6.5% and the mean survival 10.3 +/- 2.7 months with extremes of 2 to 72 months. The large variability of this survival is not in relation with the quality of the anastomosis but with the extent and the evolutivity of the carcinoma. Among the surgical and non-surgical palliative treatments of carcinomas of the hilus, the intrahepatic cholangio-anastomosis is the procedure which gives the best comfort and less iatrogenic complications.