The following statement(s) is/are true concerning the surgical therapy of cholangiocarcinomas

a.A resectable distal bile duct carcinoma is best treated by a Whipple procedure

b.Klatskin tumors may require hepatic resection in attempt for potential cure

c.Regardless of the surgical resection for proximal biliary tumors, stenting of the biliary anastomosis is important

The surgical treatment of a cholangiocarcinoma is dependent upon its location. For lesions of the middle third of the bile duct, resection of the bile duct tumor with reanastomosis is the procedure of choice when possible. For distal lesions, the Whipple procedure (pancreaticoduodenectomy) is often necessary. Overall, both middle and lower third lesions have a better prognosis than tumors in the hilum. The prognosis for patients with hilar bile duct cancer (Klatskin tumors) is extremely poor with mortality rates of 80% to 90% in five years. Most patients are unresectable at the time of diagnosis. Unless contraindicated for other reasons, however, surgical exploration should be performed in all patients whose tumors are potentially resectable. Hepatic lobectomy is indicated for potential cure if the bile duct lesion extends into the hepatic parenchyma. Regardless of the surgical therapy, stenting of the biliary anastomosis is important since postoperative strictures or recurrent tumors are common and long-standing stents allow for cholangiographic followup and for dilatation should strictures arise. These stents have also been used for placement of iridium seeds used for local irradiation. More aggressive surgical therapy including complete hepatic resection followed by hepatic transplantation have been performed. However, the results have been associated with a very high rate of recurrence in the posttransplantation period and therefore at the present time this treatment is not recommended.