Cancer of the extrahepatic bile ducts and the gallbladder: Surgical management

Cholangiocarcinoma is often divided into two types, intra- and extrahepatic – the latter group often classified into lesions of the proximal, middle and distal thirds of the extrahepatic ductal system. However, we (1, 2) and others (3, 4) have used a simpler and more surgically relevant three-tiered classification system: Intrahepatic lesions are those confined to the liver and not involving the extrahepatic biliary tree. Perihilar tumors are those involving or requiring resection of the hepatic duct bifurcation, typically arising in the extrahepatic biliary tree proximal to the origin of the cystic duct. Distal tumors are extrahepatic lesions located in the peripancreatic region. Intrahepatic cholangiocarcinoma is often considered to be a different disease than perihilar or distal cholangiocarcinoma, with distinct clinical, therapeutic and epidemiologic differences (2, 5), and is discussed elsewhere in this book. The present chapter focuses on the surgical treatment of extrahepatic cancers of the biliary system – namely, perihilar and distal cholangiocarcinoma and gallbladder cancer. History: The history of biliary tract surgery begins at least as long ago as the Middle Ages, but documentation of early procedures is sparse. Animal experiments were common in the seventeenth century (6). The first case of extrahepatic cholangiocarcinoma was reported in 1840 by Durand-Fardel (7) in a series of six cases of cancer of the extrahepatic biliary tree: three cases of gallbladder cancer, two cases of intrahepatic cholangiocarcinoma and one case of cholangiocarcinoma of the common bile duct.