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Treatment of Gallbladder and Bile Duct Cancer

Surgical removal (resection) is currently the only hope for a cure for biliary tract carcinoma. These operations are difficult, and the most experienced surgeons generally obtain the best outcomes. At The Johns Hopkins Hospital, we have multiple surgeons with a strong interest in treating cancers of the gall bladder and bile duct. These include the Chairman of Surgery, Dr. John Cameron, Dr. Kurtis Campbell and Dr. Richard Schulick, all of whom have extensive experience operating on the extrahepatic and intrahepatic bile ducts, and gallbladder. Dr. Michael Choti is a surgeon here at Hopkins with extensive experience operating on the intrahepatic tumors. The location of the tumor dictates which operation will be performed, as detailed below.

Gallbladder cancers are treated by resection (surgical removal) of the gallbladder (cholecystectomy). Low stage tumors can be resected with a minimally invasive procedure called "laparoscopic cholecystectomy". Here, the surgeon operates through small finger-sized openings made in the abdomen. A camera and surgical instruments mounted on probes are inserted through the small openings. When the tumor is more advanced, an open cholecystectomy is performed in which the surgeon removes the gallbladder, a portion of the adjacent liver, and regional lymph nodes. Here, a standard larger abdominal incision is made.

Bile duct cancers within the liver (Intrahepatic cholangiocarcinomas) are treated by segmental resection of a portion of the liver. Occasionally, complete removal of the liver (hepatectomy) with liver transplantation will be attempted.

Bile duct cancers near the confluence (joining) of the bile ducts (perihilar cholangiocarcinoma) are treated differently depending upon how extensive the tumor is. Tumors confined below the right and left hepatic ducts are treated with resection of the extrahepatic bile ducts, gallbladder, and lymph nodes. Tumors that extend above the duct confluence may require resection of a lobe of the liver.

Perihilar Illustration Postperihilar Illustration

Distal bile duct cancers (those near the ampulla of Vater) are treated with a Whipple resection, which is a resection of the proximal duodenum (first portion of the small intestine), head of the pancreas, common bile duct, and gallbladder. The Whipple procedure is the same operation performed for cancers of the head of the pancreas. More Whipple resections are performed at The Johns Hopkins Hospital than at any hospital in the world.

Whipple Specimen Illustration Post-Whipple Illustration

If the tumor cannot be removed surgically, bypass procedures may be performed to prevent obstruction of the gastrointestinal and biliary tracts, and to relieve the patient's symptoms.

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