[Cholangiocarcinoma of the main biliary tract. Judging its resectability by imaging procedures]

Eighteen patients with main biliary tract cholangiocarcinomas and no spread to the gallbladder and to the papilla of Vater underwent a combined US, ERCP/PTC and CT study. Angiography was performed on a selected group of 12 patients. We divided the infiltrating, polypoid or stenosing lesions in three groups: upper portion tumors, involving the confluence and the common hepatic duct (8 patients); middle portion tumors, originating from the common bile duct between the confluence of the cystic duct and the upper duodenal profile (6 patients); and finally lower third tumors, originating from the common bile duct between the upper rim of the duodenum and the papilla of Vater (4 patients). According to ERCP and/or PTC, US, CT and angiographic findings, only 9 of 18 cholangiocarcinomas were judged as resectable. The authors stress the need to optimize the use of imaging methods: US can locate the biliary obstruction; ERCP and/or PTC can show the tumor and its spread out of the duct, and finally angiography can exclude or confirm the vascular involvement of the hepatic hilum.