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Treatment of cholangiocarcinoma
Last reviewed: 04.07.2025

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Treatment of cholangiocarcinoma is surgical
If cholangiocarcinoma is localized in the distal part of the biliary system, it can be excised; the survival rate for 1 year is about 70%. If the localization is more proximal, tumor removal is combined with liver resection up to lobectomy; in this case, the bifurcation of the common bile duct is excised and a bilateral hepaticojejunostomy is performed.
Some authors advocate the removal of the caudate lobe, since 2-3 bile ducts of this lobe flow into the hepatic ducts directly near the place of their confluence, and therefore the probability of their being affected by a tumor is high.
The proportion of resectable cholangiocarcinomas in specialized centers has increased from 5-20% in the 1970s to 40% or more in the 1990s. This is due to earlier diagnosis and referral of patients to such centers, more accurate and complete preoperative examination, and greater radicality of the surgery. The complexity of the surgery is due to the need to remove the tumor within healthy tissue. The average survival after extended resection for cholangiocarcinoma of the liver porta is 2-3 years; with a fairly good quality of life achieved during most of this period. With local resection of Bismuth types I and II tumors, perioperative mortality does not exceed 5%. For type III lesions, liver resection is necessary, accompanied by higher mortality and complication rates.
Liver transplantation for cholangiocarcinoma is ineffective because in most cases relapses occur in the early postoperative period.
Palliative surgical interventions include the formation of an anastomosis of the jejunum with the duct of segment III of the left lobe, which is usually accessible despite the damage to the liver hilum by the tumor. In 75% of cases, jaundice can be eliminated for at least 3 months. If it is not possible to create an anastomosis with the duct of segment III (atrophy, metastases), a right-sided intrahepatic anastomosis with the duct of segment V is created.
Roentgen-surgical and endoscopic palliative methods of treatment of cholangiocarcinoma
Before surgery and in unresectable tumors, jaundice and itching can be eliminated by endoscopic or percutaneous stent placement.
If endoscopic stenting fails, it is combined with percutaneous stenting, which allows success in almost 90% of cases. The most common early complication is cholangitis (7%). Mortality within 30 days ranges from 10 to 28% depending on the size of the tumor in the liver hilum; survival averages 20 weeks.
Percutaneous transhepatic stenting is also effective, but has a higher risk of complications, including bleeding and bile leakage. Stents and metal meshes, after placement through a 5 or 7 F catheter, expand to a diameter of 1 cm; they are more expensive than plastic ones, but their patency in periampullary strictures is maintained longer. These stents can be used for strictures in the hilum area. Initial studies have shown that in this case they also have approximately the same advantages over plastic stents, but the surgeon requires more experience during installation.
Comparative evaluation of surgical and non-surgical palliative interventions has not been performed. Both approaches have their advantages and disadvantages. Non-surgical methods should be used in high-risk groups when the expected survival is low.
Biliary drainage can be combined with internal radiation therapy using iridium-192 guidewires or radium needles. The effectiveness of this treatment method has not been proven. The use of cytostatic drugs is ineffective. Remote radiation therapy, according to retrospective studies, has some effectiveness, which was not confirmed in randomized trials. Symptomatic therapy is aimed at correcting chronic cholestasis.
Prognosis of cholangiocarcinoma
The prognosis is determined by the location of the tumor. When located distally, tumors are more often resectable than when localized in the liver porta.
The prognosis for more differentiated tumors is better than for undifferentiated ones. The prognosis is most favorable for polypoid cancer.
The 1-year survival rate without resection is 50%, 20% for 2 years, and 10% for 3 years. These data show that some tumors grow slowly and metastasize at late stages. Jaundice can be eliminated surgically or by endoscopic or percutaneous stenting. The threat to life is due not so much to the degree of malignancy of the tumor as to its location, which can make the tumor unresectable. After tumor excision, the average life expectancy of patients increases, which makes a thorough examination necessary for surgical intervention.