Bile Duct and Gallbladder Tumors

  • Stefano Cirillo
  • Alessandro FerreroEmail author
  • Teresa Gallo
  • Nadia Russolillo
  • Stefano Cavanna
Part of the Cancer Dissemination Pathways book series (CDP)


Bile duct carcinoma is a rare condition, accounting for less than 2% of all tumors, but its prognosis, despite multimodal treatments, remains dismal. Radical resection with a microscopically negative margin is the only curative therapy. Thus, identifying precisely the anatomical tumor site and extension is mandatory for a correct surgical planning. Surgical strategy is largely conditioned by the ways of tumor spread. The extension of the bile duct carcinoma is classified into two types: vertical spread to adjacent tissues, such as liver parenchyma, portal venous system, the hepatic artery, and lymph nodes and horizontal spread along the axis of the bile ducts.

This chapter will focus on hilar and gallbladder carcinomas.


  1. 1.
    Blechacz BR, Gores GJ (2008) Cholangiocarcinoma. Clin Liver Dis 12(1):131–150. ixCrossRefPubMedGoogle Scholar
  2. 2.
    Chung YE et al (2009) Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29(3):683–700CrossRefPubMedGoogle Scholar
  3. 3.
    Bile Duct Cancer (Cholangiocarcinoma), American Cancer Society (2016)
  4. 4.
    Hsing AW, Rashid A, Devesa SS et al (2006) Biliary tract cancer. In: Cancer epidemiology and prevention, 3rd edn. Oxford University Press, New York, pp 878–900Google Scholar
  5. 5.
    Khan SA et al (2008) Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB 10:77–82CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Abou-Alfa GK, Jarnagin W, Lowery M et al (2014) Chapter 80: liver and bile duct cancer. In: Abeloff’s clinical oncology, 5th edn. Elsevier, PhiladelphiaGoogle Scholar
  7. 7.
    Thomas CR, Fuller CD (2008) Biliary tract and gallbladder cancer: diagnosis & therapy. Demosmedical, New YorkGoogle Scholar
  8. 8.
    Herma JM et al (2008) Biliary tract and gallbladder cancer: a multidisciplinary approach, 2nd edn. Demosmedical, New YorkGoogle Scholar
  9. 9.
    Nakanuma Y, Kakuda Y (2015) Pathologic classification of cholangiocarcinoma: new concepts. Best Pract Res Clin Gastroenterol 29:277–293CrossRefPubMedGoogle Scholar
  10. 10.
    Wan X-S, Xu Y-Y, Qian J-Y et al (2013) Intraductal papillary neoplasm of the bile duct. World J Gastroenterol 19(46):8595–8604CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New York, pp 201–205. 219–230CrossRefGoogle Scholar
  12. 12.
    Ruys AT et al (2013) Prognostic impact of preoperative imaging parameters on resectability of hilar cholangiocarcinoma. HPB Surg 2013:657309CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Suarez-Munoz MA et al (2013) Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol 5(7):132–138CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Blechacz BR et al (2011) Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 8(9):512–522CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K (2005) Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103(6):1210–1216CrossRefPubMedGoogle Scholar
  16. 16.
    Vogel A et al (2014) The diagnosis and treatment of cholangiocarcinoma. Dtsch Arztebl Int 111(44):748–754PubMedPubMedCentralGoogle Scholar
  17. 17.
    Mansour JC et al (2015) Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford) 17(8):691–699CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Vilgrain V (2008) Staging cholangiocarcinoma by imaging studies. HPB 10:106–109CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Choi JI et al (2008) Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 191(5):1448–1457CrossRefPubMedGoogle Scholar
  20. 20.
    Cui XY et al (2012) Diffusion-weighted MR imaging for detection of extrahepatic cholangiocarcinoma. Eur J Radiol 81(11):2961–2965CrossRefPubMedGoogle Scholar
  21. 21.
    Ringe KI, Wacker F (2015) Radiological diagnosis in cholangiocarcinoma: application of computed tomography, magnetic resonance imaging, and positron emission tomography. Best Pract Res Clin Gastroenterol 29(2):253–265. Epub 2015 Feb 17CrossRefPubMedGoogle Scholar
  22. 22.
    Chung YE et al (2008) Staging of extrahepatic cholangiocarcinoma. Eur Radiol 18:2182–2195. CrossRefPubMedGoogle Scholar
  23. 23.
    Kanthan R et al (2015) Gallbladder cancer in the 21st century. J Oncol 2015:967472CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lai CH, Lau WY (2008) Gallbladder cancer-a comprehensive review. Surgeon 6(2):101–110CrossRefPubMedGoogle Scholar
  25. 25.
    Russolillo N, D’Eletto M, Langella S, Perotti S, Lo Tesoriere R, Forchino F, Ferrero A (2016) Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients. Surg Endosc 30(3):1212–1218CrossRefPubMedGoogle Scholar
  26. 26.
    Jarnagin WR, Bowne W, Klimstra DS, Ben-Porat L, Roggin K, Cymes K, Fong Y, DeMatteo RP, D’Angelica M, Koea J, Blumgart LH (2005) Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg 241(5):703–712. discussion 712–4CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Valle JW, Wasan HS, Palmer DD et al (2009) Gemcitabine with or without cisplatin in patients (PTS) with advanced or metastatic biliary tract cancer (ABC): results of a multicenter, randomized phase III trial (the UK ABC-02 trial). Proc Am Soc Clin Oncol 27:4503–4503Google Scholar
  28. 28.
    Wang SJ, Lemieux A, Kalpathy-Cramer J et al (2011) Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol 29(35):4627–4632CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sakamoto E, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M, Uesaka K (1998) The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 227(3):405–411CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kitagawa Y, Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233(3):385–392CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Endo I et al (2007) Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery 142(5):666–675CrossRefPubMedGoogle Scholar
  32. 32.
    Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: nagoya experience. J Hepato-Biliary-Pancreat Surg 7(2):155–162CrossRefGoogle Scholar
  33. 33.
    Goetze TO, Paolucci V (2008) Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry. Ann Surg 247(1):104–108CrossRefPubMedGoogle Scholar
  34. 34.
    Muratore A, Bouzari H, Polastri R, Vergara V, Capussotti L (2000) Radical surgery for gallbladder cancer: a worthwhile operation? Eur J Surg Oncol 26(2):160–163CrossRefPubMedGoogle Scholar
  35. 35.
    Birnbaum DJ, Viganò L, Ferrero A, Langella S, Russolillo N, Capussotti L (2014) Locally advanced gallbladder cancer: which patients benefit from resection? Eur J Surg Oncol 40(8):1008–1015CrossRefPubMedGoogle Scholar
  36. 36.
    Sasaki R, Takahashi M, Funato O et al (2002) Hepatopancreatoduodenectomy with wide lymph node dissection for locally advanced carcinoma of the gallbladder e long-term results. Hepato-Gastroenterology 49:912–915PubMedGoogle Scholar
  37. 37.
    Birnbaum DJ, Viganò L, Russolillo N, Langella S, Ferrero A, Capussotti L (2015) Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio. Ann Surg Oncol 22(3):811–818CrossRefPubMedGoogle Scholar
  38. 38.
    Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Okushiba S (2003) Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer. Br J Surg 90(6):694–697CrossRefPubMedGoogle Scholar
  39. 39.
    Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S, Goetze TO, Paolucci V (2008) Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry. Surg Endosc 22(11):2462–2465CrossRefGoogle Scholar
  40. 40.
    Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238(5):720–727CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K (2009) No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction. J Hepato-Biliary-Pancreat Surg 16(4):502–507. Epub 2009 Apr 10CrossRefGoogle Scholar
  42. 42.
    Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y (2010) Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 252(1):115–123CrossRefPubMedGoogle Scholar
  43. 43.
    Duraker N, Sisman S, Can G (2003) The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today 33:95–100CrossRefPubMedGoogle Scholar
  44. 44.
    Murakawa K, Tada M, Takada M, Tamoto E, Shindoh G, Teramoto K et al (2004) Prediction of lymph node metastasis and perineural invasion of biliary tract cancer by selected features from cDNA array data. J Surg Res 122:184–194CrossRefPubMedGoogle Scholar
  45. 45.
    Shen F-Z, Zhang B-Y, Feng Y-J, Jia Z-X, An B, Liu C-C, Deng X-Y, Kulkarni AD, Lu Y (2010) Current research in perineural invasion of cholangiocarcinoma. J Exp Clin Cancer Res 29(1):24CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Maplanka C (2014) Gallbladder cancer, treatment failure and relapses: the peritoneum in gallbladder cancer. J Gastrointest Cancer 45(3):2CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Stefano Cirillo
    • 1
  • Alessandro Ferrero
    • 2
    Email author
  • Teresa Gallo
    • 1
  • Nadia Russolillo
    • 2
  • Stefano Cavanna
    • 1
  1. 1.Department of RadiologyOspedale MaurizianoTurinItaly
  2. 2.Department of General and Oncological SurgeryOspedale MaurizianoTurinItaly

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