CONTROVERSIAL ASPECTS OF DIAGNOSIS AND SURGICAL TREATMENT OF SUSPECTED DUCTAL CHOLANGIOCARCINOMA

Aim. To discuss controversial aspects of diagnosis and surgical treatment of suspected ductal cholangiocarcinoma using several clinical cases.

Material and Methods. Three cases of radically-operated patients with ductal cholangiocarcinoma are presented here. Postoperative morphologic examination did not confirm the diagnosis in all these cases.

Conclusion. A choice of surgical volume should not be based only on morphologic data, especially on preoperative data. Preoperative morphologic diagnosis is not always possible. Significant increase of CA19-9 level allows to consider an availability of cholangiocarcinoma but its normal values don’t exclude tumor either. It is necessary to take into account the functional state of liver and morphologic changes of removed liver lobe. Pancreatic head sparing surgery seems to be important in case of distal cholangiocarcinoma that will directly effect surgery volume. Therefore, preoperative morphologic diagnosis is of great value. Adequate and good-quality radical surgery for suspected Klatskin’s tumor or cholangiocarcinoma has main indisputable advantage. It allows to cure a patient with benign disease and gives a chance for a positive long-term prognosis in case of cancer. Such approach should be individual and used in specialized centres.

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