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Assessment of resectability criteria in patients with cholangiocarcinoma of the extrahepatic bile ducts

Alexander Zlatarov, Nikolai Kalvachev, Stanimir Ivanov, Anton Tonev, Nikola Kolev


Introduction: Extrahepatic cholangiocarcinoma is a rare disease (1 in 100, 000) affecting the biliary tree, and most commonly the confluence of the left and the right hepatic ducts (40 - 60% of all cases). The most common presenting symptom is jaundice. Various diagnostic modalities are used to assess the resectability of the cholangiocarcinoma. The primary criteria used for that are the size of the lesion, involvement of blood and biliary vessels and metastases. Currently surgery is the only definitive treatment. The aim of the following report is to present the resectability criteria and their imaging features.

Materials and Methods: We present four patients with cholangiocarcinoma who were treated in `First Clinic of Surgery` at `St. Marina University Hospital`. The median age was 68,5 years. The patients underwent preoperative ultrasound, computed tomography, magnetic resonance cholangiopancreatography and positron-emission tomography. Their final clinical or pathological (c/p) staging with the TNM system (tumor size, lymph node involvement, distant metastases) was as follows: Patient I - pT1NxMx, Patient II - cT2cNxcM1, Patient III - pT3NxM1, Patient IV - cT3cN1cM1. The first two patients were also classified as Bismuth-Corlette type 3b. Different resectability factors as cholangiocarcinoma size, secondary biliary radicles infiltration, portal vein occlusion, and liver atrophy were taken into account.

Results: Patient I and III were indicated for surgery. In the first, the procedure was curative. A left hemihepatectomy with hepaticojejunostomy was performed. The rest of the patients were not radically resectable due to high comorbidity, the presence of liver infiltration or distant metastases. Percutaneous biliary drainage was performed as a palliative procedure.

Conclusion: The extrahepatic cholangiocarcinoma is rare disease and is often unresectable. In order to plan the most suitable surgical procedure the preoperative diagnostics should be precise and include all modalities. Often the extrahepatic cholangiocarcinoma manifests itself at an advanced stage and palliative options should be considered as well.


cholangiocarcinoma, Klatskin; resectability criteria



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