الفهرس 
Anattomy off tthee Biilliiarry TrraccttOnly 14 pages are availabe for public view
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Abstract
This study was carried out on 40 patients who underwent surgery for
cholangiocarcinoma at The National Liver Institute (El-Menofia University),
and the General Surgery Department (Surgical Oncology Unit) Tanta University
Hospitals from June 2011 to June 2016. It included 22 prospectively planned
patients and 18 retrospective patients. The mean age of the studied patients was
52.97±9.69 years. The age ranged between 33 and 70 years. This study included
24 (60%) males & 16 (40%) females. Many patients experienced more than one
symptom. Jaundice was the commonest symptom in 34 patients (85.0%)
followed by abdominal pain in 21 patients (52.5%). Weight loss was a
presenting symptom in 15 patients (37.5%), anorexia in 8 patients (20%), fever
in 6 patients (15%) and vomiting in 2 patients (5%).
Preoperative biliary drainage was done for 19 patients (47.5%), 15
patients (37.5%) with ERCP stenting and 4 patients (10%) with PTD. six
patients (15%) were presented by preoperative cholangitis. Hilar CCA was the
most common type in the studied group counting to 24 patients (60%) followed
by distal CCA in 11 patients (27.5%) then intra hepatic CCA in 5 patients
(12.5%)
In hilar cholangiocarcinoma, right hepatectomy done in 12 patients
(30%), left hepatectomy in 9 patients (22.5%), 3 cases (7.5%) were locally
advanced and biliary decompression was done with palliative bypass .In distal
CCA group 10 cases Whipple procedure was done and 1case was locally
advanced and biliary decompression was done by palliative bypass. In
intrahepatic cholangiocarcinoma (5 cases) hepatic resection was done.
The mean operative time was in hilar CCA 416.00±103.36 with
range180-600 minutes. While it was 342.00±92.17 in distal CCA with range
135
Summary and Conclusion
150-510 minutes and in intrahepatic CCA it was 291.60±76.44 with range 210-
360 minutes.
The minimum blood loss intraoperatively was 200cc while the maximum
blood loss was 3000cc. The hospital stay ranged from 5 days to 36 days (mean
12.05±6.85). Intraoperative complications occurred in two cases, one of them
was hilar cholangiocarcinoma and complicated by hemorrhage due to injury of
IVC, the other case was intrahepatic CCA and complicated by hemorrhage due
to injury of right portal vein and injury of the right and left hepatic duct.
Regarding tumor differentiation moderately differentiated was the most
common type in 19 cases (52.8%) followed by well differentiated in 12 cases
(33.3%) then poorly differentiated in 5 cases (13.9%). Pathologically lymph
node invasion was found in 15 patients (41.7%), 27 (75%) patients did not have
microvascular invasion while 6 (25%) patients had positive microvascular
invasion. As regard perineural invasion 15 cases (41.7%) had perineural
invasion. Pathologically free resection margins were reported in 29 patients
(80.5%).
The most frequent complication was bile leak occurred in 5 patients
(12.5%), Intra-abdominal collection occurred in 3 cases (7.5), Portal vein
thrombosis occurred in 1 case (2.5%), pancreatic leak occurred in 1 case
(2.5%), liver cell failure occurred in 1 patient, burst abdomen occurred in 1
patient (2.5%), delayed gastric emptying occurred in 1 patient (2.5%) and
wound infection occurred in 3 cases. Delayed complications occurred in 3 cases
(7.5%), 2 cases.