Surgery to remove bile duct cancer

Surgery for bile duct cancer aims to remove the cancer and some healthy tissue around the tumour. It gives the best chance of curing someone with bile duct cancer. Bile duct cancer is also called cholangiocarcinoma.

Surgery to remove bile duct cancer isn’t for everyone. Less than 3 out of every 10 people (less than 30%) diagnosed with bile duct cancer can have surgery to remove the cancer. This is because most people are diagnosed when the cancer has already spread to other parts of the body. This is called advanced bile duct cancer.

How doctors decide if I can have surgery to remove bile duct cancer

Your team looks at your tests and scan results to see if they can remove (resect) the cancer or not. If your surgeon thinks they can remove it, they call this resectable cancer.

They also look at how well you are overall. Having an operation to remove bile duct cancer is a major surgery. You need to be generally fit to have this operation.

Unfortunately, it is common for bile duct cancer to come back even after surgery. And there is a risk of problems after this operation. Your surgeon will talk to you about:

• whether they can remove all the cancer
• what the operation involves
• the risk of the cancer coming back
• the possible complications and side effects

Types of surgery to remove bile duct cancer

The type of surgery you have depends on where the bile duct cancer is. There are 3 types of bile duct cancer:

• intrahepatic bile duct cancer
• perihilar bile duct cancer
• distal extrahepatic bile duct cancer

Surgery to remove intrahepatic bile duct cancer

Intrahepatic bile duct cancer starts in the bile ducts in the liver. Your surgeon may be able to remove it and some of the surrounding liver tissue. This operation is called liver resection or a hepatectomy.

The liver is made up of 2 main lobes, the right and the left lobe. Sometimes the surgeon needs to remove one of the lobes of the liver. This operation is called a lobectomy.

Having part of your liver removed might sound frightening. You might worry that the remaining liver may not work well enough afterwards. But if you don’t have other problems with your liver, it will usually grow back and work normally.

If you have a medical condition called cirrhosis, you might not have enough healthy liver tissue for your body to cope with afterwards. Your doctor will check how well your liver works before your operation.

Surgery to remove perihilar bile duct cancer

Perihilar bile duct cancer develops in the bile ducts just outside the liver, where the right and left hepatic ducts join together.

The type of surgery you have depends on where the cancer is and how big it is. The surgeon might remove:

• the bile ducts outside the liver (extra hepatic bile ducts)
• part of the liver
• the gallbladder
• the nearby lymph nodes

Surgery to remove distal extra hepatic bile duct cancer

Distal bile duct cancer starts in the bile ducts near the pancreas and small bowel.

Surgery to remove distal bile duct cancer usually includes removing:

• the bile ducts outside the liver (extra hepatic bile ducts)
• nearby lymph nodes
• part of the pancreas and small bowel (duodenum)

Doctors call this operation a pancreaticoduodenectomy (pank-ree-at-ic-oh dew-oh-den-ek-tom-ee).

Risk of the cancer coming back after surgery

After any cancer surgery there is a risk that the cancer may come back. The risk of this happening depends on a number of factors including:

• the size of your cancer and how far it has grown
• where it is in the body
• whether the surgeon can remove a clear margin of tissue from all around the cancer
• whether there are cancer cells in the nearby lymph nodes

During the operation, your surgeon removes the tumour and a border of tissue around it that does not contain any cancer cells. They called this a clear margin.

It can be difficult for the surgeon to remove a clear margin around bile duct cancers because of the position of the bile ducts and their closeness to other organs. This increases the risk of the cancer coming back.

Your surgeon will talk to you about the risk of the cancer coming back, and help answer any of your questions about the operation.

Treatment to lower the risk of the cancer coming back

After surgery, your doctor might suggest you have treatment to lower the chances of the cancer coming back. This is called adjuvant therapy. You usually have chemotherapy with a drug called capecitabine for 6 months after surgery.

Problems after surgery

Complications after bile duct surgery can be serious. Possible problems include bleeding and liver failure.