title: Surgical approaches to the management of primary biliary cholangiocarcinoma of the porta hepatis: the decision-making dilemma.
abstract: Fifty patients with proximal malignant biliary obstruction confined to or above the junction of the main hepatic ducts underwent surgical treatment. Group A patients (n = 30) underwent complete or partial removal of the tumor with no supplementary procedure, group B patients (n = 20) complete removal of the tumor and a supplementary procedure. Additional procedures were liver resection alone (11/20), and liver resection plus resection and reconstruction of regional vascular structures (9/20). Reconstruction of the intrahepatic biliary tree was carried out in all patients using intrahepatic cholangiojejunostomies between common segmental hepatic stomata and a Roux-en-Y jejunal loop. In each common segmental hepatic stoma, two or three segmental hepatic ducts were drained. Transanastomotic tubes were used only temporarily. Eight patients died, three from group A (3/30) and five from group B (5/20). Survivors were relieved of jaundice and had no subsidiary cholangitis or problems associated with the anastomotic tubes. Seventeen patients of group A and 12 of group B are alive, with a mean survival of 29 and 31 months, respectively. Both alternatives offer good results. The choice of the surgical approach should be based on a precise evaluation of each patient's anatomical and individual clinical peculiarities.
authors.affiliation: Department of Surgery, University of Amsterdam, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: M N
authors.initials: MN
authors.lastname: van der Heyde
authors.forename: H J
authors.initials: HJ
authors.lastname: Houthoff
mesh_terms: D002759:Adenoma, Bile Duct / Q000601:surgery*; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged