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Bile Duct Surgery
What Is Bile Duct Cancer?

Also known as a cholangiocarcinoma. It originates from the epithelium (inner lining) of the bile duct, which is a tube that carries bile from the liver to the duodenum. The gallbladder is portion of the bile duct. A cancer of the bile duct will typically obstruct the bile duct, resulting in jaundice. Other non-malignant diseases can cause jaundice as well, and must be distinguished. These include liver dysfunction, gallstones, and problems with the pancreas. Bile duct cancers can be difficult to diagnose, and frequently the decision to operate depends on the whole clinical spectrum, rather than a specific tissue diagnosis.  Pre-op evaluation includes ERCP, CT scan, possibly PTC (percutaneous transhepatic cholangiopancreatography).  Unfortunately, adequate tissue prior to surgery for diagnosis may be obtained in only 50 to 75% of patients.

Bile Duct Cancer Surgery

The surgery depends on the location of the tumor. The ability to remove the tumor ranges from 50% to 85%. The bile duct can be divided into thirds.

A tumor of the lower third of the bile duct requires a Whipple (pancreaticoduodenectomy… see above).

Tumors of the middle one third are often gallbladder cancers and require a radical cholecystectomy (removal of the gallbladder, lymph nodes, and a portion of the liver)

Tumors of the upper third, known as Klatskin tumors have the lowest resectability rate. This requires a resection of the upper and middle third of the bile duct, often part of the liver, with reconstruction of the bile duct to the intestine.

The complication rate is similar to a Whipple, with a 40 to 50% morbidity (complication rate) and a 5 to 8 % mortality.

Pre-Op Evaluation
  • CT scan, ERCP, possible PTC possible endoscopic ultrasound and possibly cardiac and pulmonary evaluation.

  • Do not take blood thinners 5 days before surgery.

  • Typically patients will be admitted the day before surgery for bowel prep.

  • You will be on clear liquids the day before your surgery. Do not eat and drink within 6 hours of surgery.

  • If you have had prior Staph infections, please let your surgeon know.

  • Patients with gallbladder cancer will usually have a laparoscopy prior to planned resection.

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Post-Op Care
  • Many patients will be discharged with a drain or stent for biliary secretions. This will require emptying twice a day. You will be instructed in the hospital.

  • You can shower; walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 3 weeks

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