The principal end-point of treatment of cholangiocarcinoma is resection with negative margins, but this goal fails in one-half to two-thirds of case [1,2]. Only Nimura’s group reports a resectability rate of 80% [1, 2, 3]. Therefore most patients with cholangiocarcinoma need palliative treatment of jaundice; moreover, local recurrence with relapse of jaundice, which is the most frequent problem after surgery, also requires palliation.


Photodynamic Therapy Biliary Drainage Palliative Treatment Biliary Tract Cancer Hilar Cholangiocarcinoma 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chari RS, Anderson CA, Saverese DMF (2003) Treatment of cholangiocarcinoma II. In: Rose BD (ed) UpToDate. UpToDate, Wellesley, MAGoogle Scholar
  2. 2.
    Vauthey JN, Blumgart LH (1994) Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 14(2):109–114PubMedCrossRefGoogle Scholar
  3. 3.
    Nimura Y, Kamiya J, Kondo S et al (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7(2):155–162PubMedCrossRefGoogle Scholar
  4. 4.
    Abraham NS, Barkun JS, Barkun An (2002) Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56(6):835–841PubMedCrossRefGoogle Scholar
  5. 5.
    Bismuth H, Malt RA (1979) Current concepts in cancer: carcinoma of the biliary tract. N Engl J Med 301(13):704–706PubMedCrossRefGoogle Scholar
  6. 6.
    Dowsett JF, Vaira D, Hatfield AR et al (1989) Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 96(4):1180–1186PubMedGoogle Scholar
  7. 7.
    Traynor O, Castaing D, Bismuth H (1987) Left intrahepatic cholangio-enteric anastomosis (round ligament approach): an effective palliative treatment for hilar cancers. Br J Surg 74(10):952–954PubMedCrossRefGoogle Scholar
  8. 8.
    Singhal D, van Gulik TM, Gouma DJ (2005) Palliative management of hilar cholangiocarcinoma. Surg Oncol 14(2):59–74PubMedCrossRefGoogle Scholar
  9. 9.
    Abu-Hamda EM, Baron TH (2004) Endoscopic management of cholangiocarcinoma. Semin Liver Dis 24(2):165–175PubMedCrossRefGoogle Scholar
  10. 10.
    Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9(1):43–57PubMedCrossRefGoogle Scholar
  11. 11.
    Gerhards MF, van Gulik TM, Gonzalez Gonzalez D et al (2003) Results of postoperative radiotherapy for resectable hilar cholangiiocarcinoma. World J Surg 27(2):173–179PubMedGoogle Scholar
  12. 12.
    Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366(9493):1303–1314PubMedCrossRefGoogle Scholar
  13. 13.
    Shapiro MJ (1995) Management of malignant biliary obstruction: nonoperative and palliative techniques. Oncology 9(6):493–496, discussion 499–500, 503PubMedGoogle Scholar
  14. 14.
    England RE, Martin DF (1996) Endoscopic and percutaneous interevention in malignant obstructive jaundice. Cardiovasc Intervent Radiol 19(6):381–387PubMedGoogle Scholar
  15. 15.
    Nelsen KM, Kastan DJ, Shetty PC et al (1996) Utilization pattern and efficacy of nonsurgical techniques to establish drainage for high biliary obstruction. J Vasc Interv Radiol 7(5):751–756PubMedCrossRefGoogle Scholar
  16. 16.
    Cowling MG, Adam AN (2001) Internal stenting in malignant biliary obstruction. World J Surg 25(3):355–359; discussion 359–361PubMedCrossRefGoogle Scholar
  17. 17.
    Lillemoe KD, Cameron JL (2000) Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg 7(2):115–121PubMedCrossRefGoogle Scholar
  18. 18.
    Liu CL, Lo CM, Lai EC, Fan ST (1998) Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumours. Arch Surg 133(3):293–296PubMedCrossRefGoogle Scholar
  19. 19.
    De Palma GD, Galloro G, Siciliano S et al (2001) Unilateral verus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 53(6):547–553PubMedCrossRefGoogle Scholar
  20. 20.
    Venbrux AC (2001) Current status of endoscopic pancreaticobiliary interventions. J Vasc Interv Radiol 12:155–162Google Scholar
  21. 21.
    Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340(8834–8835): 1488–1492PubMedCrossRefGoogle Scholar
  22. 22.
    Kaassis M, Boyer J, Dumas R et al (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57(2):178–182PubMedCrossRefGoogle Scholar
  23. 23.
    Prat F, Chapat O, Ducot B et al (1998) A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 47(1):1–7PubMedCrossRefGoogle Scholar
  24. 24.
    Wagner HJ, Knyrim K, Vakil N, Klose KJ (1993) Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 25(3):213–218PubMedGoogle Scholar
  25. 25.
    Glattli A, Stain SC, Baer HU et al (1993) Unresectable malignant biliary obstruction: treatment by self-expandable biliary endoprostheses. HPB Surg 6(3):175–184PubMedCrossRefGoogle Scholar
  26. 26.
    Cheng JL, Bruno MJ, Bergman JJ et al (2002) Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc 56(1):33–39PubMedCrossRefGoogle Scholar
  27. 27.
    Deviere J, Baize M, de Toeuf J, Cremer M (1988) Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 34(2):95–101PubMedGoogle Scholar
  28. 28.
    Inal M, Akgul E, Aksungur E, Seydaoglu G (2003) Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 14(11):1409–1416PubMedGoogle Scholar
  29. 29.
    Watanapa P (1996) Recovery patterns of liver function after complete and partial surgical biliary decompression. Am J Surg 171(2):230–234PubMedCrossRefGoogle Scholar
  30. 30.
    Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140(2):170–178PubMedGoogle Scholar
  31. 31.
    Blumgart LH, Kelley CJ (1984) Hepaticojejunostomy in benign and malignant high bile duct stricture: approaches to the left hepatic ducts. Br J Surg 71(4):257–261PubMedCrossRefGoogle Scholar
  32. 32.
    Connors S, Wigmore SJ, Madhavan KK et al (2005) Surgical palliation for unresectable hilar cholangiocarcinoma. HPB Surg 7:273–277Google Scholar
  33. 33.
    Jarnagin WR, Burke E, Powers C et al (1998) Intrahepatic biliary enteric bypass provides effective palliation in selected patients with malignant obstruction at the hepatic, duct confluence. Am J Surg 175(6):453–460PubMedCrossRefGoogle Scholar
  34. 34.
    Chaudhary A, Dhar P, Tomey S et al (1997) Segment III cholangiojejunostomy for carcinoma of the gallbladder. World J Surg 21(8):866–870: discussion 870–871PubMedCrossRefGoogle Scholar
  35. 35.
    Guthrie CM, Banting SW, Garden OJ, Carter DC (1994) Segment III cholangio jejunostomy for palliation of malignant hilar obstruction. Br J Surg 81(11):1639–1641PubMedCrossRefGoogle Scholar
  36. 36.
    Kapoor VK, Pradeep R, Haribhakti SP et al (1996) Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg 83(12):1709–1711PubMedCrossRefGoogle Scholar
  37. 37.
    Launois B, Reding R, Lebeau G, Buard JL (2000) Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg 7(2):128–134PubMedCrossRefGoogle Scholar
  38. 38.
    Jarnagin WR, Fong Y, DeMatteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234(4):507–517: discussion 517–519PubMedCrossRefGoogle Scholar
  39. 39.
    Berr F, Wiedmann M, Tannapfel A et al (2000) Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology 31(2):291–298PubMedCrossRefGoogle Scholar
  40. 40.
    Kajanti M, Pyrhonen S (1994) Epirubicin-sequential methotrexate-5-fluorouracil-leucovorin treatment in advanced cancer of the extrahepatic biliary system. A phase II study. Am J Clin Oncol 17(3):223–226PubMedCrossRefGoogle Scholar
  41. 41.
    Takada T, Kato H, Matsushiro T et al (1994) Comparison of 5-fluorouracil, doxorubicin and mitomycin C with 5-fluorouracil alone in the treatment of pancreatic-biliary carcinomas. Oncology 51(5):396–400PubMedGoogle Scholar
  42. 42.
    Mazhar D, Stebbing J, Bower M (2006) Chemotherapy for advanced cholangio carcinoma: what is standard treatment? Future Oncol 2(4):509–514PubMedCrossRefGoogle Scholar
  43. 43.
    Thongprasert S (2005) The role of chemotherapy in cholangiocarcinoma. Ann Oncol 16(Suppl 2):ii93–ii96PubMedCrossRefGoogle Scholar
  44. 44.
    Patt YZ, Hassan MM, Lozano RD et al (2001) Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer. Clin Cancer Res 7(11):3375–3380PubMedGoogle Scholar
  45. 45.
    Patt YZ, Jones DV Jr, Hoque A et al (1996) Phase II trial of intravenous fluorouracil and subcutaneous interferon alfa-2b for biliary tract cancer. J Clin Oncol 14(8):2311–2315PubMedGoogle Scholar
  46. 46.
    Ellis PA, Norman A, Hill A et al (1995). Epirubicin, cisplatin and infusional 5-fluorouracil (5-FU) (ECF) in hepatobiliary tumours. Eur J Cancer 31A(10):1594–1598PubMedCrossRefGoogle Scholar
  47. 47.
    Glimelius B, Hoffman K, Sjoden PO et al (1996) Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 7(6):593–600PubMedGoogle Scholar
  48. 48.
    Cantore M, Mambrini A, Fiorentini G et al (2005) Phase II study of hepatic intraarterial epirubicin and cisplatin, with systemic 5-fluorouracil in patients with unresectable biliary tract tumours. Cancer 103(7):1402–1407PubMedCrossRefGoogle Scholar
  49. 49.
    Mezger J, Sauerbruch T, Ko Y et al (1998) Phase II trial of gemcitabine in gallbladder and biliary tract carcinomas. Onkologie 21:232–234CrossRefGoogle Scholar
  50. 50.
    Dobrila-Dintinjana R, Kovac D, Depolo A et al (2000) Gemcitabine in patients with nonre-sectable cancer of the biliary system or advanced gallbladder cancer. Am J Gastroenterol 95:2476Google Scholar
  51. 51.
    Kuhn R, Hribaschek A, Eichelmann K et al (2002) Outpatient therapy with gemcitabine and docetaxel for gallbladder, biliary, and cholangio-carcinomas. Invest New Drugs 20(3):351–356PubMedCrossRefGoogle Scholar
  52. 52.
    Carraro S, Servienti PJ, Bruno MF (2001) Gemcitabine and cisplatin in locally advanced or metastatic gallbladder and bile duct adenocancer. Proc Am Soc Clin Oncol 20:146B (abs 2333)Google Scholar
  53. 53.
    Doval DC, Sekhon JS, Gupta SK et al (2004) A phase II study of gemcitabine and cisplatin in chemotherapy-naive, unresectable gall bladder cancer. Br J Cancer 90(8):1516–1520PubMedCrossRefGoogle Scholar
  54. 54.
    Andre T, Tournigand C, Rosmorduc O et al: GER COR Group (2004) Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GER COR study. Ann Oncol 15(9):1339–1343.PubMedCrossRefGoogle Scholar
  55. 55.
    Shinchi H, Takao S, Nishida H, Aikou T (2000) Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma. J Surg Oncol 75(2):89–94PubMedCrossRefGoogle Scholar
  56. 56.
    Ishii H, Furuse J, Nagase M et al (2004) Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology 51(58):954–957PubMedGoogle Scholar
  57. 57.
    Ohnishi H, Asada M, Shichijo Y et al (1995) External radiotherapy for biliary decompression of hilar cholangiocarcinoma. Hepatogastroenterology 42(3):265–268PubMedGoogle Scholar
  58. 58.
    Crane CH, Macdonald KO, Vauthey JN et al (2002) Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys 53(4):969–974PubMedCrossRefGoogle Scholar
  59. 59.
    Kuvshinoff BW, Armstrong JG, Fong Y et al (1995) Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg 82(11):1522–1525PubMedCrossRefGoogle Scholar
  60. 60.
    Vallis KA, Benjamin IS, Munro AJ et al (1996) External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability. Radiother Oncol 41(1):61–66PubMedCrossRefGoogle Scholar
  61. 61.
    Foo ML, Gunderson LL, Bender CE, Buskirk SJ (1997) External radiation therapy, and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 39(4):929–935PubMedCrossRefGoogle Scholar
  62. 62.
    Ortner MA, Liebetruth J, Schreiber S et al (1998) Photodynamic therapy of nonresectable cholangiocarcinoma. Gastroenterology, 114(3):536–542PubMedCrossRefGoogle Scholar
  63. 63.
    Ortner ME, Caca K, Berr F et al (2003) Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 125(5):1355–1363PubMedCrossRefGoogle Scholar
  64. 64.
    Witzigmann H, Berr F, Ringel U et al (2006) Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg244(2):230–239PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Personalised recommendations