Malignant Diseases of the Gallbladder and Bile Ducts

  • Steven A. Ahrendt
  • Thomas H. Magnuson


Gallbladder and bile duct cancers are relatively uncommon malignancies and tend to occur primarily in elderly patients. Although the overall prognosis of these malignancies remains poor, recent advances in hepatobiliary surgery, perioperative care, and adjuvant therapy have helped to improve overall survival and quality of life. A multidisciplinary approach in the management of these patients, including surgery, medical oncology, radiation oncology, and invasive radiology, is critical to achieving favorable results.


Bile Duct Gallbladder Cancer Choledochal Cyst Extrahepatic Bile Duct Biliary Tract Cancer 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jones RS. Carcinoma of the gallbladder. Surg Clin North Am 1990;70:1419–1428.PubMedGoogle Scholar
  2. 2.
    Piehler JM, Crichlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet 1978;147:929–939.PubMedGoogle Scholar
  3. 3.
    Carriaga MT, Henson DE. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 1995;75:171–190.PubMedCrossRefGoogle Scholar
  4. 4.
    Ransohoff DF, Gracie WA. Treatment of gallstones. Ann Intern Med 1993;119:606–619.PubMedCrossRefGoogle Scholar
  5. 5.
    Strom BL, Soloway RD, Rios-Dalenz JL, et al. Risk factors for gallbladder cancer: an international collaborative case-control study. Cancer 1995;76:1747–1756.PubMedCrossRefGoogle Scholar
  6. 6.
    Lowenfels AB, Lindstrom CG, Conway MJ, et al. Gallstones and risk of gallbladder cancer. J Natl Cancer Inst 1985;75:77–80.PubMedGoogle Scholar
  7. 7.
    De Aretxabala X, Roa I, Burgos L, et al. Gallbladder cancer in Chile: a report on 43 potentially resectable tumors. Cancer 1992;69:60–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Nervi F, Duarte I, Gomez G, et al. Frequency of gallbladder cancer in Chile: a high-risk area. Int J Cancer 1988; 41:657–660.PubMedCrossRefGoogle Scholar
  9. 9.
    Pitt HA, Dooley WC, Yeo CJ, et al. Malignancies of the biliary tree. Curr Probl Surg 1995;32:1–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Wibbenmeyer LA, Wade TP, Chen RC, et al. Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder. J Am Coll Surg 1995;181:504–510.PubMedGoogle Scholar
  11. 11.
    Liu KJM, Richter HM, Cho MJ, et al. Carcinoma involving the gallbladder in elderly patients presenting with acute cholecystitis. Surgery 1997;122:748–756.PubMedCrossRefGoogle Scholar
  12. 12.
    Zatonski WA, Lowenfels AB, Boyle P, et al. Epidemiologic aspects of gallbladder cancer: a case-control study of the SEARCH program of the international agency for research on cancer. J Natl Cancer Inst 1997;89:1132–1138.PubMedCrossRefGoogle Scholar
  13. 13.
    Fahim RB, McDonald JR, Richards JC, et al. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 1962;156:114–123.PubMedCrossRefGoogle Scholar
  14. 14.
    Shirai Y, Yoshida K, Tsukada K, et al. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 1992;79:659–662.PubMedCrossRefGoogle Scholar
  15. 15.
    Shirai Y, Tsukada K, Ohtani T, et al. Hepatic metastases from carcinoma of the gallbladder. Cancer 1995;75:2063–2068.PubMedCrossRefGoogle Scholar
  16. 16.
    American Joint Committee on Cancer. Gallbladder and extrahepatic bile ducts. In: Beahrs OH, Henson DE, Hutter RVP et al. (eds) Manual for the Staging of Cancer. Philadelphia: Lippincott, 1993:111–120.Google Scholar
  17. 17.
    White K, Kraybill WG, Lopez MJ: Primary carcinoma of the gallbladder: TNM staging and prognosis. J Surg Oncol 1988;39:251–255.PubMedCrossRefGoogle Scholar
  18. 18.
    Soyer P, Gouhiri M, Boudiaf M, et al. Carcinoma of the gallbladder: imaging features with surgical correlation. Am J Radiol 1997;169:781–785.Google Scholar
  19. 19.
    Mizuguchi M, Kudo S, Fukahori T, et al. Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer. Eur Radiol 1997;7: 1323–1327.PubMedCrossRefGoogle Scholar
  20. 20.
    Shirai Y, Yoshida K, Tsukada K, et al. Inapparent carcinoma of the gallbladder: an appraisal of a radical second operation after simple cholecystectomy. Ann Surg 1992;215: 326–331.PubMedCrossRefGoogle Scholar
  21. 21.
    Donohue JH, Nagorney DM, Grant CS, et al. Carcinoma of the gallbladder: does radical resection improve outcome? Arch Surg 1990;125:237–241.PubMedCrossRefGoogle Scholar
  22. 22.
    Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder: results of the French Surgical Association survey. Ann Surg 1994;219:275–280.PubMedCrossRefGoogle Scholar
  23. 23.
    Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661–667.PubMedCrossRefGoogle Scholar
  24. 24.
    Tsukada K, Hatakeyama K, Kurosaki I, et al. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 1996;120:816–822.PubMedCrossRefGoogle Scholar
  25. 25.
    Ogura Y, Mizumoto R, Isaji S, et al. Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg 1991;15:337–343.PubMedCrossRefGoogle Scholar
  26. 26.
    Ouchi K, Suzuki M, Tominaga T, et al. Survival after surgery for cancer of the gallbladder. Br J Surg 1994; 81:1655–1657.PubMedCrossRefGoogle Scholar
  27. 27.
    Nakamura S, Nishiyama R, Yokoi Y, et al. Hepatopancre-atoduodenectomy for advanced gallbladder carcinoma. Arch Surg 1994;129:625–629.PubMedCrossRefGoogle Scholar
  28. 28.
    Gall FP, Kockerling F, Scheele J, et al. Radical operations for carcinoma of the gallbladder: present status in Germany. World J Surg 1991;15:328–336.PubMedCrossRefGoogle Scholar
  29. 29.
    Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer: implications for staging and management. Ann Surg 1996;224:639–646.PubMedCrossRefGoogle Scholar
  30. 30.
    Bloechle C, Izbicki JR, Passlick B, et al. Is radical surgery in locally advanced gallbladder carcinoma justified? Am J Gastroenterol 1995;90:2195–2200.PubMedGoogle Scholar
  31. 31.
    Jones RS. Palliative operative procedures for carcinoma of the gallbladder. World J Surg 1991;15:348–351.PubMedCrossRefGoogle Scholar
  32. 32.
    Miyazaki M, Itoh H, Ambiru S, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg 1996;83:478–481.PubMedCrossRefGoogle Scholar
  33. 33.
    Falkson G, Maclntyre JM, Moertel CG. Eastern Cooperative Oncology Group experience with chemotherapy for inoperable gallbladder and bile duct cancer. Cancer 1984;54:965–969.PubMedCrossRefGoogle Scholar
  34. 34.
    Gebbia V, Majello E, Testa A, et al. Treatment of advanced adenocarcinomas of the exocrine pancreas and the gallbladder with 5-fluorouracil, high dose levofolinic acid and oral hydroxyurea on a weekly schedule. Cancer 1996; 78:1300–1307.PubMedCrossRefGoogle Scholar
  35. 35.
    Kraybill WG, Lee H, Picus J, et al. Multidisciplinary treatment of biliary tract cancers. J Surg Oncol 1994;55:239–245.PubMedCrossRefGoogle Scholar
  36. 36.
    Todoroki T, Iwasaki Y, Orii K, et al. Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma. World J Surg 1991;15:357–366.PubMedCrossRefGoogle Scholar
  37. 37.
    Todoroki T. Radiation therapy for primary gallbladder cancer. Hepatogastroenterology 1997;44:1229–1239.PubMedGoogle Scholar
  38. 38.
    Gameron JL, Pitt HA, Zinner MJ, et al. Management of proximal cholangiocarcinoma by surgical resection and radiotherapy. Am J Surg 1990;159:91–98.CrossRefGoogle Scholar
  39. 39.
    Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996;224:463–475.PubMedCrossRefGoogle Scholar
  40. 40.
    Tompkins RK, Saunders K, Roslyn JJ, et al. Changing patterns in diagnosis and management of bile duct cancer. Ann Surg 1990;211:614–621.PubMedGoogle Scholar
  41. 41.
    Nagorney DM, Donohue JH, Farnell MB, et al. Outcomes after curative resections of cholangiocarcinoma. Arch Surg 1993;128:871–877.PubMedCrossRefGoogle Scholar
  42. 42.
    Broe PJ, Cameron JL. The management of proximal biliary tract tumors. Adv Surg 1981;15:47–62.PubMedGoogle Scholar
  43. 43.
    Sons HU, Borchard F. Carcinoma of the extrahepatic bile ducts: a postmortem study of 65 cases and review of the literature. J Surg Oncol 1987;34:6–12.PubMedCrossRefGoogle Scholar
  44. 44.
    Miller BA, Ries LAG, Hankey BF, et al. SEER Cancer Statistics Review: 1973–1990. NIH Publ No. 93–2789. Bethesda: National Cancer Institute, 1993.Google Scholar
  45. 45.
    Ahrendt SA, Pitt HA, Kalloo AN, et al. Primary sclerosing cholangitis: resect, dilate, or transplant? Ann Surg 1998; 227:412–423.PubMedCrossRefGoogle Scholar
  46. 46.
    Lipsett PA, Pitt HA, et al. Choledochal cyst disease: a changing pattern of presentation. Ann Surg 1994;220: 644–652.PubMedCrossRefGoogle Scholar
  47. 47.
    Sheen-Chen SM, Chou FF, Eng HL. Intrahepatic cholangiocarcinoma in hepatolithiasis: a frequently overlooked disease. J Surg Oncol 1991;47:131–135.PubMedCrossRefGoogle Scholar
  48. 48.
    Fan ST, Lai EC, Wong J. Hepatic resection for hepatolithiasis. Arch Surg 1993;128:1070–1074.PubMedCrossRefGoogle Scholar
  49. 49.
    Chijiiwa K, Ichimiya H, Kuroki S, et al. Late development of cholangiocarcinoma after the treatment of hepatolithiasis: immunohistochemical study of mucin carbohydrates and core proteins in hepatolithiasis and cholangiocarcinoma. Int J Cancer 1993;55:82–91.CrossRefGoogle Scholar
  50. 50.
    Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 1992;215:31–38.PubMedCrossRefGoogle Scholar
  51. 51.
    Ramage JK, Donaghy A, Farrant JM. Serum tumor markers for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastroenterology 1995;108:865–869.PubMedCrossRefGoogle Scholar
  52. 52.
    Langer JC, Langer B, Taylor BR, et al. Carcinoma of the extrahepatic bile ducts: results of an aggressive surgical approach. Surgery 1985;98:752–759.PubMedGoogle Scholar
  53. 53.
    Looser CH, Stain SC, Baer HU, et al. Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and preoperative findings. Br J Radiol 1992;65:871–877.PubMedCrossRefGoogle Scholar
  54. 54.
    Yamashita Y, Takahashi M, Kanazawa S, et al. Parenchymal changes of the liver in cholangiocarcinoma: CT evaluation. Gastrointest Radiol 1992;17:161–166.PubMedCrossRefGoogle Scholar
  55. 55.
    Hann LE, Graetrex KV, Bach AM, et al. Cholangiocarcinoma at the hepatic hilus: sonographic findings. Am J Radiol 1997;168:985–989.Google Scholar
  56. 56.
    Saeki M, Pitt HA, Tempany CM. Magnetic resonance imaging of hilar cholangiocarcinoma [abstract]. In: Proceedings of the International Hepatobiliary Pancreatic Association, 1992:100A.Google Scholar
  57. 57.
    Lomanto D, Pavone P, Laghi A, et al. Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancre-atic disease. Am J Surg 1997;174:33–38.PubMedCrossRefGoogle Scholar
  58. 58.
    Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 1985;201:545–553.PubMedCrossRefGoogle Scholar
  59. 59.
    Nakeeb A, Pitt HA. The role of preoperative biliary decompression in obstructive jaundice. Hepatogastroenterology 1995;42:332–339.PubMedGoogle Scholar
  60. 60.
    Little JM. A prospective evaluation of computerized estimates of risk in the management of obstructive jaundice. Surgery 1987;102:473–476.PubMedGoogle Scholar
  61. 61.
    Cope C, Marinelli DL, Weinstein JK. Transcatheter biopsy of lesions obstructing the bile ducts. Radiology 1988;169: 555–560.PubMedGoogle Scholar
  62. 62.
    Desa LA, Akosa AB, Lazzara S, et al. Cytodiagnosis in the management of extrahepatic biliary stricture. Gut 1991; 32:1188–1191.PubMedCrossRefGoogle Scholar
  63. 63.
    Ferrucci JT, Chuttani R. Magnetic resonance cholangiopancreatography (MRCP): comparison to invasive cholangiopancreatography. Hepatology 1995;22:107A.Google Scholar
  64. 64.
    Foutch PG, Kerr DM, Horlan JR, et al. Endoscopic retrograde wire-guided brush cytology for diagnosis of patients with malignant obstruction of the bile duct. Am J Gastroenterol 1990;85:791–795.PubMedGoogle Scholar
  65. 65.
    Pitt HA, Cameron JL, Postier RG, et al. Factors influencing mortality in biliary tract surgery. Am J Surg 1981;141:66–72.PubMedCrossRefGoogle Scholar
  66. 66.
    Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996;223:384–394.PubMedCrossRefGoogle Scholar
  67. 67.
    Lynn RB, Wilson JAP, Cho KJ. Cholangiocarcinoma: role of percutaneous transhepatic cholangiography in determination of resectability Dig Dis Sci 1988;33:587–592.PubMedCrossRefGoogle Scholar
  68. 68.
    Dooley WC, Pitt HA, Venbrux AD, et al. Is angiography useful in patients with perihilar cholangiocarcinoma [abstract]. In: Proceedings of the International Hepatobiliary Pancreatic Association, 1992:32A.Google Scholar
  69. 69.
    Dooley WC, Cameron JL, Pitt HA, et al. Is preoperative angiography useful in patients with periampullary tumors? Ann Surg 1990;211:649–655.PubMedCrossRefGoogle Scholar
  70. 70.
    Nordback IH, Pitt HA, Coleman JA, et al. Unresectable hilar cholangiocarcinoma: percutaneous versus operative palliation. Surgery 1994;115:5977–603.Google Scholar
  71. 71.
    Soto JA, Carish MA, Yucel EK, et al. Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology 1996;110: 589–597.PubMedCrossRefGoogle Scholar
  72. 72.
    Lee MG, Lee HJ, Kim MH, et al. Extrahepatic biliary diseases: 2D MR cholangiography compared with endoscopic retrograde cholangiopancreatography. Radiology 1997; 202:663–669.PubMedGoogle Scholar
  73. 73.
    Hausegger KA, Kleinert R, Lammer J, et al. Malignant biliary obstruction: histologic findings after treatment with self-expandable stents. Radiology 1992;185:461–464.PubMedGoogle Scholar
  74. 74.
    Lai EC, Chu KM, Lo CY, et al. Choice of palliation for malignant hilar obstruction. Am J Surg 1992;163:208–212.PubMedCrossRefGoogle Scholar
  75. 75.
    Lamere JS, Stoker J, Dees J, et al. Non-surgical palliative treatment of patients with malignant biliary obstruction: the place of endoscopic and percutaneous drainage. Clin Radiol 1987;38:603–608.CrossRefGoogle Scholar
  76. 76.
    Schima W, Prokesch R, Osterreicher C, et al. Biliary wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction. Clin Radiol 1997;52:213–219.PubMedCrossRefGoogle Scholar
  77. 77.
    Peters RA, Williams SG, Lombard M, et al. The management of high-grade hilar structures by endoscopic insertion of self-expanding metal endoprosthesis. Endoscopy 1997;29:10–16.PubMedCrossRefGoogle Scholar
  78. 78.
    O’Brien S, Hatfield AR, Craig PI, et al. A three year follow up of self-expanding metal stents in the endoscopic palliation of long-term survivors with malignant biliary obstruction. Gut 1995;36:618–621.PubMedCrossRefGoogle Scholar
  79. 79.
    Becker CD, Glattie A, Mailbach R, et al. Percutaneous palliation of malignant obstructive jaundice with wall stent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction. J Vasc Intervent Radiol 1993;4:597–604.CrossRefGoogle Scholar
  80. 80.
    Pitt HA. Proximal bile duct: resection and palliation. In: Daly JM, Cady B (eds) Atlas of Surgical Oncology. St. Louis: Mosby-Year Book, 1993:417–437.Google Scholar
  81. 81.
    Yeo CJ, Pitt HA, Cameron JL. Cholangiocarcinoma. Surg Clin North Am 1990;70:1429–1447.PubMedGoogle Scholar
  82. 82.
    Ahrendt SA, Pitt HA. Cholangiocarcinoma. In: Niederhuber JE (ed) Curent Therapy in Oncology. St. Louis: Mosby-Year Book, 1993:410–414.Google Scholar
  83. 83.
    Lillemoe KD, Pitt HA, Kaufmann SL, et al. Acute cholecystitis occurring as a complication of percutaneous transhepatic drainage. Surg Gynecol Obstet 1989;168:348–352.PubMedGoogle Scholar
  84. 84.
    Crist DW, Kadir S, Cameron JL. Proximal biliary tract reconstruction: the value of preoperatively placed percutaneous biliary catheters. Surg Gynecol Obstet 1987;165: 421–426.PubMedGoogle Scholar
  85. 85.
    Stain SC, Baer HU, Dennison AR, et al. Current management of hilar cholangiocarcinoma. Surg Gynecol Obstet 1992;175:579–588.PubMedGoogle Scholar
  86. 86.
    Ouchi K, Matsuno S, Sato T. Long-term survival in carcinoma of the biliary tract. Arch Surg 1989;124:248–252.PubMedCrossRefGoogle Scholar
  87. 87.
    Bengmark S, Ekberg H, Evander A, et al. Major liver resection for hilar cholangiocarcinoma. Ann Surg 1988;207:120–128.PubMedCrossRefGoogle Scholar
  88. 88.
    Fortner JG, Vitelli CE, Maclean BJ. Proximal extrahepatic bile duct tumors: analysis of a series of 52 consecutive patients treated over a period of 13 years. Arch Surg 1989;124:1275–1282.PubMedCrossRefGoogle Scholar
  89. 89.
    Lai ECS, Tompkins RK, Roslyn JJ, et al. Proximal bile duct cancer: quality of survival. Ann Surg 1987;205:111–118.PubMedCrossRefGoogle Scholar
  90. 90.
    Hadjis NS, Blenkhard JI, Alexander N, et al. Outcome of radical surgery in hilar cholangiocarcinoma. Surgery 1990;107:597–604.PubMedGoogle Scholar
  91. 91.
    Boerma EJ. Research into the results of resection of hilar bile duct cancer. Surgery 1990;108:572–580.PubMedGoogle Scholar
  92. 92.
    Baer HU, Stain SC, Dennison AR, et al. Improvements in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 1993;217:20–27.PubMedCrossRefGoogle Scholar
  93. 93.
    Vauthey JN, Baer HU, Guastella T, et al. Comparison of outcome between extended and nonextended liver resections for neoplasms. Surgery 1993;114:968–975.PubMedGoogle Scholar
  94. 94.
    Kawasaki S, Makuuchi M, Miyagawa S, et al. Radical operation after portal embolization for tumor of hilar bile duct. J Am Coll Surg 1994;178:480–486.PubMedGoogle Scholar
  95. 95.
    Nagino M, Nimura Y, Kamiya J, et al. Right or left trisegmental portal vein embolization before hepatic triseg-mentectomy for hilar bile duct carcinoma. Surgery 1995; 117:677–681.PubMedCrossRefGoogle Scholar
  96. 96.
    Nimura Y, Hayakawa N, Kamiya J, et al. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg 1991;78:727–731.PubMedCrossRefGoogle Scholar
  97. 97.
    Reding R, Buard JL, Lebeau G, et al. Surgical management of 552 carcinomas of the extrahepatic bile ducts: results of the French Surgical Association survey. Ann Surg 1991;213:236–241.PubMedCrossRefGoogle Scholar
  98. 98.
    Sugiura Y, Nakamura S, Iida S, et al. Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group. Surgery 1994;115: 445–451.PubMedGoogle Scholar
  99. 99.
    Washburn WK, Lewis DW, Jenkins RL. Aggressive surgical resection for cholangiocarcinoma. Arch Surg 1995;130: 270–276.PubMedCrossRefGoogle Scholar
  100. 100.
    Cameron JC. Atlas of Surgery, vol 1. Philadelphia: B.C. Decker, 1990.Google Scholar
  101. 101.
    Guthrie CM, Haddock G, de Beaux AC, et al. Changing trends in the management of extrahepatic cholangiocarcinoma. Br J Surg 1993;80:1434–1439.PubMedCrossRefGoogle Scholar
  102. 102.
    Lillemoe KD, Sauter PK, Pitt HA, et al. Current status of surgical palliation of periampullary carcinoma. Surg Gynecol Obstet 1993;176:1–10.PubMedGoogle Scholar
  103. 103.
    Casavilla FA, Marsh JW, Iwatsuki S, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg 1997;195:429–436.Google Scholar
  104. 104.
    Klempnauer J, Ridder GJ, von Wasielewski R, et al. Resec-tional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 1997;15:947–954.PubMedGoogle Scholar
  105. 105.
    Hayes JK Jr, Sapozink MD, Miller FJ. Definitive radiation therapy in bile duct carcinoma. Int J Radiat Oncol Biol Phys 1988;15:735–740.PubMedCrossRefGoogle Scholar
  106. 106.
    Verbeek PC, van Leeuwen DJ, van der Heyde MN, et al. Does additive radiotherapy after hilar resection improve survival of cholangiocarcinoma: an analysis in sixty-four patients. Ann Chir 1991;45:350–354.PubMedGoogle Scholar
  107. 107.
    Shiina T, Mikuriya S, Uno T, et al. Radiotherapy of cholangiocarcinoma: the roles for primary and adjuvant therapies. Cancer Chemother Pharmacol 1992;31(suppl):S115–S118.PubMedCrossRefGoogle Scholar
  108. 108.
    Ede RJ, Williams SJ, Hatfield ARW, et al. Endoscopic management of inoperable cholangiocarcinoma using iridium-192. Br J Surg 1989;76:867–871.PubMedCrossRefGoogle Scholar
  109. 109.
    Koyama K, Tanaka J, Sato S, et al. New strategy for treatment of carcinoma of the hilar bile duct. Surg Gynecol Obstet 1989;168:523–529.PubMedGoogle Scholar
  110. 110.
    Pitt HA, Nakeeb A, Abrams RA, et al. Perihilar cholangiocarcinoma: postoperative radiotherapy does not improve survival. Ann Surg 1995;221:788–798.PubMedCrossRefGoogle Scholar
  111. 111.
    Minsky BD, Kemeny N, Armstrong JG, et al. Extrahepatic biliary system cancer: an update of a combined modality approach. Am J Clin Oncol 1991;14:433–439.PubMedCrossRefGoogle Scholar
  112. 112.
    Koyama K, Tanaka J, Sato Y, et al. Experience in twenty patients with carcinoma of hilar bile duct treated by resection, targeting chemotherapy and intercavitary irradiation. Surg Gynecol Obstet 1993;176:239–245.PubMedGoogle Scholar
  113. 113.
    Robertson JM, Lawrence TD, Dworzanin LM, et al. Treatment of primary hepatobiliary cancer with conformai radiation therapy and regional chemotherapy. J Clin Oncol 1993;11:1286–1292.PubMedGoogle Scholar
  114. 114.
    Kraybill WG, Lee H, Picus J, et al. Multidisciplinary treatment of biliary tract cancers. J Surg Oncol 1994;55:239–245.PubMedCrossRefGoogle Scholar
  115. 115.
    Whittington R, Neuberg D, Teste WJ, et al. Protracted intravenous fiuorouracil infusion with radiation therapy in the management of localized pancreaticobiliary carcinoma: a phase I Eastern Cooperative Oncology Group trial. J Clin Oncol 1995;13:227–234.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Steven A. Ahrendt
  • Thomas H. Magnuson

There are no affiliations available

Personalised recommendations