BILE DUCT CANCER SURGERY

What is Bile Duct Cancer Surgery?

Cholangiocarcinoma or bile duct cancer is cancer in the bile ducts that carry the digestive fluid bile and connect the liver to the gallbladder and, finally, to your small intestine.

Classification of cholangiocarcinoma is based on the position of cancer in the bile ducts:

  • Intrahepatic cholangiocarcinomaoccurs in the bile duct parts within the liver.
  • Perihilar cholangiocarcinomaoccurs in the regions of bile ducts outside of the liver.
  • Distal cholangiocarcinomaappears in the amount of the bile duct near the small intestine.

SURGERY:

There are two basic types of surgery for bile duct cancer: 

  • Potentially curative surgery (resectable and unresectable) 
  • Palliative surgery.

Potentially curative surgery for bile duct cancer

Resectable or potentially curative surgery involves image tests that show there’s a chance that the surgeon can remove all cancer with a margin of healthy tissue around it.

The surgery to treat bile duct cancer is often complicated and demands an experienced surgeon. If a tumor or cancer is unresectable, it means the cancer is too advanced and has spread too far and difficult to be entirely removed by surgery.

Laparoscopy to plan bile duct surgery

Before a curative surgery, the surgeon performed a laparoscopy to see how far cancer has spread and if curative surgery is an option or notices. Laparoscopy can help the operation to remove resectable cancer. 

Surgery to treat bile duct cancer has serious side effects and, If your cancer is very unlikely to be curable, be sure to understand all the pros and cons of surgery. 

Surgery for resectable bile duct cancers

For resectable cancers, the surgery depends on the position of the tumor in the bile duct.

  • For Intrahepatic bile duct cancers:the surgeon cuts cancer containing part of the liver. Sometimes a whole lobe (either right or left part) of the liver can be removed. This is called a hepatic lobectomy. This is a complicated procedure that requires an experienced surgeon and skilled team.
  • For Perihilar bile duct cancer the surgeon usually removes part of the liver, together with the bile duct, gallbladder, nearby lymph nodes, part of the pancreas, and small intestine. Then the surgeon links the remaining ducts directly to the small intestine. This is a more complex operation.
  • For Distal bile duct cancers. During the surgery to treat distal bile duct cancer, the surgeon, Along with the bile duct and surrounding lymph nodes, removes part of the pancreas and small intestine. This operation is often referred to as the Whipple procedure. 

Surgery for unresectable bile duct cancers

Treatment for unresectable cancer is less likely to be done, but some procedures can be helpful.

Liver transplant

Surgery for early-stage, unresectable Perihilar bile duct cancers involve removing the liver and bile ducts and then transplanting a donor’s liver. It is found beneficial to cure cancer. Like other surgeries for bile duct cancer, a liver transplant is a profitable and significant operation with some risks of bleeding, infection, etc. 

After a liver transplant, an immune suppressant must be taken to suppress the patient’s immune system to keep it from rejecting the new liver. These drugs are also associated with their risks and side effects. After a liver transplant, there’s a need to check regular blood tests. 

Palliative surgery for bile duct cancer

Palliative surgery is done to relieve symptoms and to prevent complications, like blockage of the bile ducts. This surgery is selected when the cancer is too widespread. Palliative surgery will not cure cancer, can help a person feel better, and sometimes live longer.

Biliary Bypass

During this, the surgeon usually creates a bypass around the tumor to block the bile duct by connecting the bile’s blocked part with a part of the duct that lies past the blockage or is attached to the intestine itself. 

Stent Placement

 The surgeon will put a plastic or expandable metal tube, called a stent, inside the bile duct to keep it open, and it will also help the bile to flow.