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Liver Cancer pp 463-483 | Cite as

Hilar Cholangiocarcinoma: Photodynamic Therapy and Stenting

  • Marcus Wiedmann
  • Joachim Mössner
  • Helmut Witzigmann
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Part of the Methods of Cancer Diagnosis, Therapy and Prognosis book series (HAYAT, volume 5)

Carcinomas of the biliary tree are rare tumors of the gastrointestinal tract with rising inci dence during the last years. Endoscopic therapy plays a central role in the preopera-tive and palliative treatment of extrahepatic cholangiocarcinoma (CC). In obstructive jaundice, biliary drainage may cause only few complications and relieves symptoms reliably. It can prevent further complica tions and is indispensable in the treatment of cholangitis. The principal drawbacks of biliary stents are stent occlusion and cholangitis. Prophylactic application of antibiotics and/or ursodeoxycholic acid has not been shown to be effective. Technical details concerning material, number and location of stents await further clarification. There are no prospective randomized tri als investigating the effect of preoperative biliary drainage on morbidity and mortality in jaundized patients before liver resection. Palliative surgical cholangio-jejunostomy with the bile duct of liver segment III for Klatskin-tumors is rarely performed due to the high success rate of stent therapy. Self-expandable metal stents (SEMS) are a safe, efficacious and less invasive treatment option for palliation of duodenal obstruc tion in biliary tract cancer. Technical com-plications can be managed endoscopically and the bile duct remains accessible for endoluminal treatment. Palliative photo-dynamic therapy (PDT) for non-resectable hilar CC is effective in prolonging survival, improving biliary drainage and quality of life, and represents a promising adjunct to palliative therapy. Early referral for PDT may provide maximum survival benefit. In contrast, neoadjuvant and adjuvant PDT for hilar CC is a new approach that needs further evaluation.

Keywords

Bile Duct Photodynamic Therapy Biliary Drainage Biliary Tract Cancer Hilar Cholangiocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Marcus Wiedmann
    • 1
  • Joachim Mössner
    • 1
  • Helmut Witzigmann
    • 1
  1. 1.Department of Internal Medicine IIUniversity of LeipzigLeipzigGermany

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