[Trends of management of carcinoma of the biliary tract].
Trends of management of carcinoma of the biliary tract are described. Ultrasonography has made it possible to perform non-invasive and routine examination for biliary disorders and to find early cancer of the gallbladder. Moreover, endoscopic ultrasonography has enabled to make a differential diagnosis and a staging diagnosis. Percutaneous transhepatic cholangioscopy has been used as the most precise diagnostic procedure and peroral cholangioscopy has been introduced as a more convenient endoscopy. Although percutaneous transhepatic biliary drainage is considered to be hazardous and disadvantageous procedure in Western countries, it is essential in Japan where radical and extended operation are frequently performed. In Japan, major hepatectomies, pancreatoduodenectomy and/or combined resections of major vessels are aggressively adopted for advanced gallbladder cancers. However, such operations are still much dangerous and long-term survivors are few. Therefore, application of these extended operation for this advanced disease should be carefully re-examined. Various hepatectomies with caudate loberesection have been performed for patients with carcinoma of the hepatic hilus. Liver transplantation is also attempted for this disease, however, not accepted generally. Pylolus preserving pancreatoduodenectomy is now being accepted for biliary malignancies, which brings excellent quality of life.
Kondo
S
S
First Dept. of Surgery, Nagoya University, School of Medicine, Japan.
Nimura
Y
Y
D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D016145:Endoscopy, Digestive System; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D014463:Ultrasonography