Main bile duct carcinoma management. Our experience on 38 cases.

BACKGROUND: Cholangiocarcinoma (CC) is rare malignant tumors arising from cells of the biliary tract. It presents some difficulties to diagnose, and is associated with a high mortality. Traditionally extrahepatic CC is divided into klatskin tumors, intermediate tract and distal or iuxtapapillar tumors according to its location within the biliary tree. CT RM, PET may provide useful diagnostic information in those patients. Surgical resection is the only chance for cure, with results depending on selected patients and careful surgical technique. Liver transplantation could offer long-term survival in selected patients when combined with chemotherapy. Chemotherapy, radiation therapy, and external drainage remain as the only treatment for inoperable patients.

MATERIAL AND METHODS: The authors report their experience since 1997 inherent to 38 cases of extrahepatic CC, 21 of which were treated by surgery: their outcome has been evaluated.

RESULTS: Surprisingly four of them (2 with intermediate tract tumor and 2 with distal tract tumors) are still alive and apparently disease-free after 5 years since surgery. Moreover another one patient with papillar tumor has reached 5 years survival despite has undergone surgery two times.

CONCLUSION: Surgery remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.