Surgical strategy of biliary papillomatosis in Western countries.
Surgical resection, considered the optimal treatment of biliary papillomatosis, often remains incomplete due to high risk of recurrence in view of positive margins or recurrence on the remnant bile duct because of its multifocality. Resection of the whole biliary tree by liver transplantation and duodenopancreatectomy can be regarded as the only curative treatment. However, this approach has resulted in unfavorable results in patients with advanced tumor invasion and/or positive lymph nodes. For the majority of biliary tumors, preoperative assessment is often insufficient. Therefore, we advocate initial partial resection as a first step to eliminate both advanced tumor invasion and/or positive lymph nodes on definitive analysis of the specimen. We propose the strategy of initial resection for selecting the patients who would actually benefit from liver transplantation.
Vibert
Eric
E
Centre HépatoBiliaire, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, University of Paris XI, 94, Villejuif, France.
Dokmak
Safi
S
Belghiti
Jacques
J
D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D000075202:Contraindications; D004108:Dilatation, Pathologic; D017809:Fatal Outcome; D005260:Female; D005602:France; D006801:Humans; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D010212:Papilloma / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D014057:Tomography, X-Ray Computed