Surgical Treatment of Distal Common Bile Duct Malignancy

Abstract

Distal cholangiocarcinoma is a rare malignant condition arising from the epithelial cells of the biliary tract. Surgical resection is the only curable alternative for patients with this disease. True resectability is often determined by surgical exploration. Duodenopancreatectomy is an extremely high-demanding technique and is the only one that can be potentially curable for patients diagnosed with resectable distal cholangiocarcinoma. Long-term survival may be achieved only in selected patients, undergoing duodenopancreatectomy, especially in patients where R0 margins are achieved. Perineural extension, pancreatic invasion, and lymph nodes involvement are the main risk factors for recurrence. Palliative biliodigestive diver-sion or endoscopic internal drainage of the biliary tree is alternative for patients with unresectable tumors. Although the prognosis after surgical treatment of distal common bile duct malignancy is better than for other periampullary tumors, the continuous progresses made in the field of surgical therapy and oncological treatment may lead to an improvement in the outcome of this neoplastic pathology.