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Chapter-02 Hilar Cholangiocarcinoma

BOOK TITLE: Roshan Lall Gupta’s: Recent Advances in Surgery-13

Author
1. Shrikhande Shailesh V
2. Goel Mahesh
3. Gaikwad Vinay
ISBN
9789350903827
DOI
10.5005/jp/books/11901_2
Edition
1/e
Publishing Year
2013
Pages
25
Author Affiliations
1. Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, India, Tata Memorial Center, Parel, Mumbai, India, Tata Memorial Hospital, Ernest, Borges Marg, Parel, Mumbai, India, Tata Memorial Hospital, Mumbai, Maharashtra, India, Tata Memorial Centre, Mumbai, Maharashtra, India, Hepato-Pancreato-Biliary, Surgical Oncology, Tata Memorial, Centre, Mumbai, Maharashtra, India
2. Tata Memorial Center, Parel, Mumbai, India, Tata Memorial Centre, Mumbai, Maharashtra, India, Tata Memorial Hospital, Mumbai, Maharashtra, India
3. Tata Memorial Center, Parel, Mumbai, India, Artemis Health Institute, Gurgaon, Haryana, India
Chapter keywords

Abstract

Hilar cholangiocarcinoma or Klatskin tumour arise at the confluence of right and left hepatic duct. These are usually adenocarcinoma, sclerosing type and has poor prognosis. The most common presentation is painless jaundice, followed by pruritus, abdominal pain, weight loss and fever. Tumour marker CA 19.9 and CEA may be elevated. CA 19.9 value more than 180 U/ml is more specific for malignancy, however, it is normal in 10% patients. High level of CA 19.9 has poor prognosis. MRCP will provide three dimensional images of biliary tree as well as vascular structure, nodal or distant metastasis and lobar atrophy. CT scan gives information about tumour extent and vascular encasement. Bismuth Corelette classification is widely used to describe the pattern of hilar cholangiocarcinoma but does not consider vascular involvement and lobar atrophy. The value of preoperative stenting in resectable tumour is controversial. Frozen section is mandatory, and negative histological margin (R0) is desirable.

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