Skip to main content
Log in

Surgical management of proximal bile duct cancers

  • Review Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tumors arising from the proximal biliary tree remain particularly challenging with respect to their evaluation and treatment. Complete resection with negative histologic margins is the most effective treatment modality.

Results

However, the majority of patients are not candidates for surgery.

Summary

Over the last decades, advances have evolved to improve resectability and morbidity after major liver and bile duct resection. However, these disease processes still pose a management challenge. Herein, we provide an overview of proximal bile duct cancers, hilar cholangiocarcinoma (HCCa) and intrahepatic cholangiocarcinoma (ICCa).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Burke EC, Jarnagin WR, Hochwald SN et al (1998) Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228(3):385–394

    Article  PubMed  CAS  Google Scholar 

  2. Nagorney DM, Donohue JH, Farnell MB et al (1993) Outcomes after curative resections of cholangiocarcinoma. Arch Surg 128(8):871–877, discussion 877-879

    Article  PubMed  CAS  Google Scholar 

  3. Nakeeb A, Pitt HA, Sohn TA et al (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224(4):463–473, discussion 473-465

    Article  PubMed  CAS  Google Scholar 

  4. Tompkins RK, Thomas D, Wile A, Longmire WP Jr (1981) Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg 194(4):447–457

    Article  PubMed  CAS  Google Scholar 

  5. Berdah SV, Delpero JR, Garcia S et al (1996) A western surgical experience of peripheral cholangiocarcinoma. Br J Surg 83(11):1517–1521

    Article  PubMed  CAS  Google Scholar 

  6. Chu KM, Lai EC, Al-Hadeedi S et al (1997) Intrahepatic cholangiocarcinoma. World J Surg 21(3):301–305, discussion 305-306

    Article  PubMed  CAS  Google Scholar 

  7. Endo I, Gonen M, Yopp AC et al (2008) Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 248(1):84–96

    Article  PubMed  Google Scholar 

  8. Harrison LE, Fong Y, Klimstra DS et al (1998) Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinoma. Br J Surg 85(8):1068–1070

    Article  PubMed  CAS  Google Scholar 

  9. Patel T, Steer CJ, Gores GJ (1999) Apoptosis and the liver: a mechanism of disease, growth regulation, and carcinogenesis. Hepatology 30(3):811–815

    Article  PubMed  CAS  Google Scholar 

  10. Saunders K, Longmire W Jr, Tompkins R et al (1991) Diffuse bile duct tumors: guidelines for management. Am Surg 57(12):816–820

    PubMed  CAS  Google Scholar 

  11. Welzel TM, Graubard BI, El-Serag HB et al (2007) Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case–control study. Clin Gastroenterol Hepatol 5(10):1221–1228

    Article  PubMed  Google Scholar 

  12. Patel T (2001) Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 33(6):1353–1357

    Article  PubMed  CAS  Google Scholar 

  13. Carriaga MT, Henson DE (1995) Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 75(1 Suppl):171–190

    Article  PubMed  CAS  Google Scholar 

  14. Greenlee RT, Hill-Harmon MB, Murray T, Thun M (2001) Cancer statistics, 2001. CA Cancer J Clin 51(1):15–36

    Article  PubMed  CAS  Google Scholar 

  15. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366(9493):1303–1314

    Article  PubMed  Google Scholar 

  16. House MG, D'Angelica MI, Jarnagin WR (2010) Extrahepatic biliary tumors. In: Jarnagin WR and LH Blumgart (eds) Blumgart's surgery of the liver, biliary tract, and pancreas, 5th edn. Elsevier, Philadelphia, PA, anticipated publication February 2012.

  17. Allen PJ, Reiner AS, Gonen M et al (2008) Extrahepatic cholangiocarcinoma: a comparison of patients with resected proximal and distal lesions. HPB (Oxford) 10(5):341–346

    Article  Google Scholar 

  18. Broome U, Olsson R, Loof L et al (1996) Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut 38(4):610–615

    Article  PubMed  CAS  Google Scholar 

  19. Katoh H, Shinbo T, Otagiri H et al (1988) Character of a human cholangiocarcinoma CHGS, serially transplanted to nude mice. Hum Cell 1(1):101–105

    PubMed  CAS  Google Scholar 

  20. Pitt HA, Dooley WC, Yeo CJ, Cameron JL (1995) Malignancies of the biliary tree. Curr Probl Surg 32(1):1–90

    Article  PubMed  CAS  Google Scholar 

  21. Pitt HA, Nakeeb A, Abrams RA et al (1995) Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival. Ann Surg 221(6):788–797, discussion 797-788

    Article  PubMed  CAS  Google Scholar 

  22. Hewitt PM, Krige JE, Bornman PC, Terblanche J (1995) Choledochal cysts in adults. Br J Surg 82(3):382–385

    Article  PubMed  CAS  Google Scholar 

  23. Jeng KS, Ohta I, Yang FS et al (1994) Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis. Arch Surg 129(10):1097–1102

    Article  PubMed  CAS  Google Scholar 

  24. Lipsett PA, Pitt HA, Colombani PM et al (1994) Choledochal cyst disease. A changing pattern of presentation. Ann Surg 220(5):644–652

    Article  PubMed  CAS  Google Scholar 

  25. Tanaka K, Ikoma A, Hamada N et al (1998) Biliary tract cancer accompanied by anomalous junction of pancreaticobiliary ductal system in adults. Am J Surg 175(3):218–220

    Article  PubMed  CAS  Google Scholar 

  26. Hakamada K, Sasaki M, Endoh M et al (1997) Late development of bile duct cancer after sphincteroplasty: a ten- to twenty-two-year follow-up study. Surgery 121(5):488–492

    Article  PubMed  CAS  Google Scholar 

  27. Chu KM, Lo CM, Liu CL, Fan ST (1997) Malignancy associated with hepatolithiasis. Hepatogastroenterology 44(14):352–357

    PubMed  CAS  Google Scholar 

  28. Kubo S, Kinoshita H, Hirohashi K, Hamba H (1995) Hepatolithiasis associated with cholangiocarcinoma. World J Surg 19(4):637–641

    Article  PubMed  CAS  Google Scholar 

  29. Jarnagin WR (2000) Cholangiocarcinoma of the extrahepatic bile ducts. Semin Surg Oncol 19(2):156–176

    Article  PubMed  CAS  Google Scholar 

  30. Weinbren K, Mutum SS (1983) Pathological aspects of cholangiocarcinoma. J Pathol 139(2):217–238

    Article  PubMed  CAS  Google Scholar 

  31. Jarnagin WR, Bowne W, Klimstra DS et al (2005) Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg 241(5):703–712, discussion 712-704

    Article  PubMed  Google Scholar 

  32. Levi S, Urbano-Ispizua A, Gill R et al (1991) Multiple K-ras codon 12 mutations in cholangiocarcinomas demonstrated with a sensitive polymerase chain reaction technique. Cancer Res 51(13):3497–3502

    PubMed  CAS  Google Scholar 

  33. Nakeeb A, Lipsett PA, Lillemoe KD et al (1996) Biliary carcinoembryonic antigen levels are a marker for cholangiocarcinoma. Am J Surg 171(1):147–152, discussion 152-143

    Article  PubMed  CAS  Google Scholar 

  34. O'Dell MR, Huang JL, Whitney-Miller CL, et al. (2012) KrasG12D and p53 mutation cause primary intra-hepatic cholangiocarcinoma. Cancer Res. Epub ahead of print.

  35. Tannapfel A, Benicke M, Katalinic A et al (2000) Frequency of p16(INK4A) alterations and K-ras mutations in intrahepatic cholangiocarcinoma of the liver. Gut 47(5):721–727

    Article  PubMed  CAS  Google Scholar 

  36. Tsuzuki T, Ogata Y, Iida S et al (1983) Carcinoma of the bifurcation of the hepatic ducts. Arch Surg 118(10):1147–1151

    Article  PubMed  CAS  Google Scholar 

  37. Shimada H, Niimoto S, Matsuba A et al (1983) The infiltration of bile duct carcinoma along the bile duct wall. Int Surg 73(2):87–90

    Google Scholar 

  38. Endo I, House MG, Klimstra DS et al (2008) Clinical significance of intraoperative bile duct margin assessment for hilar cholangiocarcinoma. Ann Surg Oncol 15(8):2104–2112

    Article  PubMed  Google Scholar 

  39. Way LW (1994) Biliary tract. In: Way LW (ed) Current surgical diagnosis and treatment, 10th edn. Appleton & Lange, Norwalk, CT, pp 537–566

    Google Scholar 

  40. Heslin MJ, Brooks AD, Hochwald SN et al (1998) A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy. Arch Surg 133(2):149–154

    Article  PubMed  CAS  Google Scholar 

  41. Are C, Gonen M, D'Angelica M et al (2006) Differential diagnosis of proximal biliary obstruction. Surgery 140(5):756–763

    Article  PubMed  Google Scholar 

  42. Wetter LA, Ring EJ, Pellegrini CA, Way LW (1991) Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors). Am J Surg 161(1):57–62, discussion 62-53

    Article  PubMed  CAS  Google Scholar 

  43. Enjoji M, Sakai H, Nakashima M, Nawata H (1998) Integrins: utility as cell type- and stage-specific markers for hepatocellular carcinoma and cholangiocarcinoma. Vitro Cell Dev Biol Anim 34(1):25–27

    Article  CAS  Google Scholar 

  44. Rabinovitz M, Zajko AB, Hassanein T et al (1990) Diagnostic value of brush cytology in the diagnosis of bile duct carcinoma: a study in 65 patients with bile duct strictures. Hepatology 12(4 Pt 1):747–752

    Article  PubMed  CAS  Google Scholar 

  45. Hann LE, Greatrex KV, Bach AM et al (1997) Cholangiocarcinoma at the hepatic hilus: sonographic findings. AJR Am J Roentgenol 168(4):985–989

    PubMed  CAS  Google Scholar 

  46. Bach AM, Hann LE, Brown KT et al (1996) Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 201(1):149–154

    PubMed  CAS  Google Scholar 

  47. Hadjis NS, Collier NA, Blumgart LH (1985) Malignant masquerade at the hilum of the liver. Br J Surg 72(8):659–661

    Article  PubMed  CAS  Google Scholar 

  48. Hadjis NS, Blumgart LH (1987) Role of liver atrophy, hepatic resection and hepatocyte hyperplasia in the development of portal hypertension in biliary disease. Gut 28(8):1022–1028

    Article  PubMed  CAS  Google Scholar 

  49. Cherqui D, Benoist S, Malassagne B et al (2000) Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 135(3):302–308

    Article  PubMed  CAS  Google Scholar 

  50. Kennedy TJ, Yopp A, Qin Y et al (2009) Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford) 11(5):445–451

    Article  Google Scholar 

  51. Farges O, Belghiti J, Kianmanesh R et al (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237(2):208–217

    PubMed  Google Scholar 

  52. Kondo S, Hirano S, Ambo Y et al (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240(1):95–101

    Article  PubMed  Google Scholar 

  53. Ito F, Cho CS, Rikkers LF, Weber SM (2009) Hilar cholangiocarcinoma: current management. Ann Surg 250(2):210–218

    Article  PubMed  Google Scholar 

  54. Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215(1):31–38

    Article  PubMed  CAS  Google Scholar 

  55. No author (2010) Chapter 21: perihilar bile ducts. In Edge SB et al (eds) AJCC cancer staging handbook, 7th edn. Lippincott Raven Publishers, Philadelphia. http://online.statref.com/document.aspx?fxid=73&docid=111

  56. Rocha FG, Matsuo K, Blumgart LH, Jarnagin WR: Hilar cholangiocarcinoma: the Memorial Sloan-Kettering Cancer Center experience. J Hepatobiliary Pancreat Sci 17(4):490-496.

  57. 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 517-509

    Article  PubMed  CAS  Google Scholar 

  58. Cunningham JD, Fong Y, Shriver C et al (1994) One hundred consecutive hepatic resections. Blood loss, transfusion, and operative technique. Arch Surg 129(10):1050–1056

    Article  PubMed  CAS  Google Scholar 

  59. Melendez JA, Arslan V, Fischer ME et al (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187(6):620–625

    Article  PubMed  CAS  Google Scholar 

  60. Mizumoto R, Suzuki H (1988) Surgical anatomy of the hepatic hilum with special reference to the caudate lobe. World J Surg 12(1):2–10

    Article  PubMed  CAS  Google Scholar 

  61. Neuhaus P, Thelen A, Jonas S, et al. (2011) Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. Epub ahead of print.

  62. 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):257–261

    Article  PubMed  CAS  Google Scholar 

  63. De Vreede I, Steers JL, Burch PA et al (2000) Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. Liver Transpl 6(3):309–316

    Article  PubMed  Google Scholar 

  64. Rea DJ, Heimbach JK, Rosen CB et al (2005) Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 242(3):451–458, discussion 458-461

    PubMed  Google Scholar 

  65. Takada T, Amano H, Yasuda H et al (2002) Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 95(8):1685–1695

    Article  PubMed  Google Scholar 

  66. Valle J, Wasan H, Palmer DH et al (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362(14):1273–1281

    Article  PubMed  CAS  Google Scholar 

  67. 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):128–134

    Article  PubMed  CAS  Google Scholar 

  68. 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):453–460

    Article  PubMed  CAS  Google Scholar 

  69. Stoker J, Lameris JS (1993) Complications of percutaneously inserted biliary Wallstents. J Vasc Interv Radiol 4(6):767–772

    Article  PubMed  CAS  Google Scholar 

  70. Liu CL, Lo CM, Lai EC, Fan ST (1998) Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. Arch Surg 133(3):293–296

    Article  PubMed  CAS  Google Scholar 

  71. Schima W, Prokesch R, Osterreicher C et al (1997) Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction. Cliln Radiol 52(3):213–219

    Article  CAS  Google Scholar 

  72. Glattli A, Stain SC, Baer HU et al (1993) Unresectable malignant biliary obstruction: treatment by self-expandable biliary endoprostheses. HPB Surg 6(3):175–184

    Article  PubMed  CAS  Google Scholar 

  73. D'Angelica MI, Jarnagin WR, Blumgart LH (2004) Resectable hilar cholangiocarcinoma: surgical treatment and long-term outcome. Surg Today 34(11):885–890

    Article  PubMed  Google Scholar 

  74. Cameron JL, Pitt HA, Zinner MJ et al (1990) Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 159(1):91–97, discussion 97-98

    Article  PubMed  CAS  Google Scholar 

  75. Hadjis NS, Blenkharn JI, Alexander N et al (1990) Outcome of radical surgery in hilar cholangiocarcinoma. Surgery 107(6):597–604

    PubMed  CAS  Google Scholar 

  76. Pichlmayr R, Weimann A, Klempnauer J et al (1996) Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg 224(5):628–638

    Article  PubMed  CAS  Google Scholar 

  77. Iwatsuki S, Todo S, Marsh JW et al (1998) Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg 187(4):358–364

    Article  PubMed  CAS  Google Scholar 

  78. Todoroki T, Kawamoto T, Koike N et al (2000) Radical resection of hilar bile duct carcinoma and predictors of survival. Br J Surg 87(3):306–313

    Article  PubMed  CAS  Google Scholar 

  79. Tamandl D, Herberger B, Gruenberger B et al (2008) Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma. Ann Surg Oncol 15(10):2787–2794

    Article  PubMed  Google Scholar 

  80. Yamasaki S (2003) Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 10(4):288–291

    Article  PubMed  Google Scholar 

  81. Poultsides GA, Zhu AX, Choti MA, Pawlik TM (2010) Intrahepatic cholangiocarcinoma. Surg Clin North Am 90(4):817–837

    Article  PubMed  Google Scholar 

  82. Chung YE, Kim MJ, Park YN et al (2009) Varying appearances of cholangiocarcinoma: radiologic–pathologic correlation. Radiographics 29(3):683–700

    Article  PubMed  Google Scholar 

  83. Manfredi R, Barbaro B, Masselli G et al (2004) Magnetic resonance imaging of cholangiocarcinoma. Semin Liver Dis 24(2):155–164

    Article  PubMed  Google Scholar 

  84. Weber SM, Jarnagin WR, Klimstra D et al (2001) Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg 193(4):384–391

    Article  PubMed  CAS  Google Scholar 

  85. Sotiropoulos GC, Bockhorn M, Sgourakis G et al (2009) R0 liver resections for primary malignant liver tumors in the noncirrhotic liver: a diagnosis-related analysis. Dig Dis Sci 54(4):887–894

    Article  PubMed  Google Scholar 

  86. Zeng ZC, Tang ZY, Fan J et al (2006) Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 75 patients. Cancer J 12(2):113–122

    PubMed  Google Scholar 

  87. Gusani NJ, Balaa FK, Steel JL et al (2008) Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter arterial chemoembolization (TACE): a single-institution experience. J Gastrointest Surg 12(1):129–137

    Article  PubMed  Google Scholar 

  88. Burger I, Hong K, Schulick R et al (2005) Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution. J Vasc Interv Radiol 16(3):353–361

    Article  PubMed  Google Scholar 

  89. Jarnagin WR, Schwartz LH, Gultekin DH et al (2009) Regional chemotherapy for unresectable primary liver cancer: results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival. Ann Oncol 20(9):1589–1595

    Article  PubMed  CAS  Google Scholar 

  90. Tan JC, Coburn NG, Baxter NN et al (2008) Surgical management of intrahepatic cholangiocarcinoma—a population-based study. Ann Surg Oncol 15(2):600–608

    Article  PubMed  Google Scholar 

  91. Inoue K, Makuuchi M, Takayama T et al (2000) Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery 127(5):498–505

    Article  PubMed  CAS  Google Scholar 

  92. Weimann A, Varnholt H, Schlitt HJ et al (2000) Retrospective analysis of prognostic factors after liver resection and transplantation for cholangiocellular carcinoma. Br J Surg 87(9):1182–1187

    Article  PubMed  CAS  Google Scholar 

  93. Konstadoulakis MM, Roayaie S, Gomatos IP et al (2008) Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery 143(3):366–374

    Article  PubMed  Google Scholar 

  94. Nakagohri T, Kinoshita T, Konishi M et al (2008) Surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg 32(12):2675–2680

    Article  PubMed  Google Scholar 

  95. Ohtsuka M, Ito H, Kimura F et al (2002) Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg 89(12):1525–1531

    Article  PubMed  CAS  Google Scholar 

  96. Paik KY, Jung JC, Heo JS et al (2008) What prognostic factors are important for resected intrahepatic cholangiocarcinoma? J Gastroenterol Hepatol 23(5):766–770

    Article  PubMed  Google Scholar 

  97. DeOliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245(5):755–762

    Article  PubMed  Google Scholar 

  98. Nathan H, Aloia TA, Vauthey JN et al (2009) A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol 16(1):14–22

    Article  PubMed  Google Scholar 

  99. Choi SB, Kim KS, Choi JY et al (2009) The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol 16(11):3048–3056

    Article  PubMed  Google Scholar 

  100. Lang H, Sotiropoulos GC, Sgourakis G et al (2009) Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg 208(2):218–228

    Article  PubMed  Google Scholar 

  101. Shimada K, Sano T, Nara S et al (2009) Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery 145(4):411–416

    Article  PubMed  Google Scholar 

  102. de Jong MC, Nathan H, Sotiropoulos GC et al (2011) Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 29(23):3140–3145

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to William R. Jarnagin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

LaFemina, J., Jarnagin, W.R. Surgical management of proximal bile duct cancers. Langenbecks Arch Surg 397, 869–879 (2012). https://doi.org/10.1007/s00423-012-0928-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-012-0928-6

Keywords

Navigation