[Proximal cancer of the biliary tracts: therapeutic attitudes]

Proximal cancer of the biliary tract involves the upper third of the bile duct including the junction of the main right and left hepatic ducts. The different therapeutic approaches include curative resection of the bile duct, with or without hepatic resection, liver transplantation and palliative procedures. The latter include surgical palliative resection, transtumoral intubation and palliative intrahepatic anastomosis, as well as non-surgical palliative intubation, usually endoscopic. Surgical curative or palliative resection is preferred. Endoscopic procedures should be reserved for inoperable patients. The survival and palliative achieved depend upon the treatment modality chosen. Surgical resection produces the best results with low operative mortality and good quality of life. Other palliative surgical and non-surgical treatment is associated with a higher operative mortality, a constant risk of cholangitis and the need for very close follow-up. It is hoped that increased knowledge will lead to higher resectability rate with improved prognosis of this gloomy disease.