Clinical Outcomes for Biliary Tract Cancer

  • Yukihiro Yokoyama
  • Masato NaginoEmail author


Surgical treatment for biliary tract cancer is challenging. Biliary cancer originating from the perihilar region is especially difficult to treat, due to anatomical ­complexity at the hepatic hilus. However, in the past few decades there have been dramatic advancements with regard to diagnosis, surgical technique, and perioperative patients’ management for biliary tract cancer. These advancements have not only decreased the rate of postoperative morbidity and mortality but have also improved patients’ survival. The standard surgical procedure for hilar cholangiocarcinoma comprises major hepatectomy combined with caudate lobectomy and extrahepatic bile duct resection. This means that surgeons must overcome the complications accompanying this highly invasive surgery. In this regard, the innovation of portal vein embolization has substantially contributed to a decrease in the risk of major hepatectomy.


Biliary tract cancer Cancer of the biliary tract Management of biliary tract ­cancer Hilar cholangiocarcinoma Hepatectomy Portal vein embolization 


  1. 1.
    Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopan­creatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38:170-175.PubMedGoogle Scholar
  2. 2.
    Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720-727.PubMedCrossRefGoogle Scholar
  3. 3.
    Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241-256.PubMedCrossRefGoogle Scholar
  4. 4.
    Altemeier WA, Gall EA, Zinninger MM, et al. Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg. 1957;75:450-460; discussion 460-451.PubMedCrossRefGoogle Scholar
  5. 5.
    Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence. Ann Surg. 2008;248:273-279.PubMedCrossRefGoogle Scholar
  6. 6.
    Sano T, Shimada K, Sakamoto Y, et al. Changing trends in surgical outcomes after major hepatobiliary resection for hilar cholangiocarcinoma: a single-center experience over 25 years. J Hepatobiliary Pancreat Surg. 2007;14:455-462.PubMedCrossRefGoogle Scholar
  7. 7.
    Dinant S, Gerhards MF, Rauws EA, et al. Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor). Ann Surg Oncol. 2006;13:872-880.PubMedCrossRefGoogle Scholar
  8. 8.
    Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro). HPB (Oxford). 2008;10:130-133.CrossRefGoogle Scholar
  9. 9.
    Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008;15:25-30.PubMedCrossRefGoogle Scholar
  10. 10.
    Unno M, Okumoto T, Katayose Y, et al. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007;14:434-440.PubMedCrossRefGoogle Scholar
  11. 11.
    Sugiura T, Nishio H, Nagino M, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478-1484.PubMedCrossRefGoogle Scholar
  12. 12.
    Nimura Y. Staging cholangiocarcinoma by cholangioscopy. HPB (Oxford). 2008;10:113-115.CrossRefGoogle Scholar
  13. 13.
    Senda Y, Nishio H, Oda K, et al. Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma—correlation between MDCT and microscopic findings. World J Surg. 2009;33(7):1459-1467.PubMedCrossRefGoogle Scholar
  14. 14.
    Nimura Y. Radical surgery: vascular and pancreatic resection for cholangiocarcinoma. HPB (Oxford). 2008;10:183-185.CrossRefGoogle Scholar
  15. 15.
    Nimura Y. Radical surgery of left-sided klatskin tumors. HPB (Oxford). 2008;10:168-170.CrossRefGoogle Scholar
  16. 16.
    Jonas S, Benckert C, Thelen A, et al. Radical surgery for hilar cholangiocarcinoma. Eur J Surg Oncol. 2008;34:263-271.PubMedCrossRefGoogle Scholar
  17. 17.
    Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol. 2008;34:787-794.PubMedCrossRefGoogle Scholar
  18. 18.
    Sugawara G, Nagino M, Nishio H, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244:706-714.PubMedCrossRefGoogle Scholar
  19. 19.
    Kamiya S, Nagino M, Kanazawa H, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239:510-517.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakeeb A, Pitt HA. Radiation therapy, chemotherapy and chemoradiation in hilar cholangiocarcinoma. HPB (Oxford). 2005;7:278-282.CrossRefGoogle Scholar
  21. 21.
    Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521-527.PubMedGoogle Scholar
  22. 22.
    Nagino M, Nimura Y, Kamiya J, et al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery. 1995;117:677-681.PubMedCrossRefGoogle Scholar
  23. 23.
    Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;137:675-680; discussion 680-671.PubMedCrossRefGoogle Scholar
  24. 24.
    Launois B, Campion JP, Brissot P, et al. Carcinoma of the hepatic hilus. Surgical management and the case for resection. Ann Surg. 1979;190:151-157.PubMedCrossRefGoogle Scholar
  25. 25.
    Blumgart LH, Hadjis NS, Benjamin IS, et al. Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet. 1984;1:66-70.PubMedCrossRefGoogle Scholar
  26. 26.
    Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31-38.PubMedCrossRefGoogle Scholar
  27. 27.
    Miyazaki M, Ito H, Nakagawa K, et al. Aggressive surgical approaches to hilar cholangiocarcinoma: Hepatic or local resection? Surgery. 1998;123:131-136.PubMedCrossRefGoogle Scholar
  28. 28.
    Ikeyama T, Nagino M, Oda K, et al. Surgical approach to bismuth Type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246:1052-1057.PubMedCrossRefGoogle Scholar
  29. 29.
    Ebata T, Nagino M, Nishio H, et al. Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg. 2007;14:131-135.PubMedCrossRefGoogle Scholar
  30. 30.
    Miyazaki M, Itoh H, Ambiru S, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg. 1996;83:478-481.PubMedCrossRefGoogle Scholar
  31. 31.
    Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996;224:463-473; discussion 473-465.PubMedCrossRefGoogle Scholar
  32. 32.
    Madariaga JR, Iwatsuki S, Todo S, et al. Liver resection for hilar and peripheral cholangiocarcinomas: a study of 62 cases. Ann Surg. 1998;227:70-79.PubMedCrossRefGoogle Scholar
  33. 33.
    Iwatsuki S, Todo S, Marsh JW, et al. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg. 1998;187:358-364.PubMedCrossRefGoogle Scholar
  34. 34.
    Nagino M, Nimura Y, Kamiya J, et al. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology. 1996;200:559-563.PubMedGoogle Scholar
  35. 35.
    Nagino M, Kamiya J, Kanai M, et al. Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery. 2000;127:155-160.PubMedCrossRefGoogle Scholar
  36. 36.
    Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364-372.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of Medicine NagoyaJapan

Personalised recommendations