Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | sâmbătă, 23 martie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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THE ACTUALLY PRINCIPLES OF THE TREATMENT IN BILIARY OBSTRUCTION FROM
EXTRAHEPATIC BILE DUCTS CANCER
A. Vasilescu, V. Strat
Clinica I Chirurgie “Tănăsescu-Buţureanu”, Sp. Universitar Sf. Spriridon
Universitatea de Medicină şi Farmacie „Gr.T.Popa” Iaşi
Jurnalul de chirurgie 2009; 5 (1): 5-25
Full text:
Format PDF (Română/Romanian)

Abstract:

The most common type of extrahepatic bile ducts cancer is the proximal segment which include the bifurcation of common hepatic duct (Klatskin’s tumors). The diagnosis of these kinds of tumors is always challenging. Magnetic resonance cholangiopancreatography (MRCP) is the best imagistic procedure also for diagnosis and for staging. Surgical resection provides the best chance for cure in patients with biliary malignancy; unfortunately only 30% from patients with Klatskin’s tumors are diagnosed in resectable stages. The type and extension of the resection depends of the tumor stage and site. Resection of the biliary duct associated with hepatectomy and/or pancreaticoduodenectomy (performed especially for limphadenectomy) has good results, from point of view of disease-free survival. In selected cases, the extrahepatic bile duct resection alone and hepatico-jejunal anastomosis is also considered as curative resection. Portal vein resection may be performed and can improve the prognosis. Palliative procedures of nonresectable bile ducts cancer consist in surgical by-pass, percutaneous biliary drainage and endoscopic endoprosthesis. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiotherapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. Radiation therapy can be associated with chemotherapy (gemcitabine) in unresectable bile duct cancer to extend survival and improve quality of life.

KEY WORDS: MALIGNANT BILIARY OBSTRUCTION, EXTRAHEPATIC BILE DUCTS CANCER, KLATSKIN TUMORS, HEPATIC RESECTION, PERCUTANEOUS BILIARY DRAINAGE, ENDOSCOPIC ENDOPROSTHESIS, RADIATION THERAPY, CHEMOTHERAPY

Correspondence to: Alin Vasilescu, MD; Assistant Professor, First Surgical Clinic „St. Spiridon” Hospital Iaşi, Independenţei Street, No 1, 700111, Iaşi, Romanai; e-mail:



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Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.