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The first 25 slides, exactly as they appear. The full deck has 161 content slides.
General Surgery
Cancer of the Gallbladder and Bile Ducts
Built from Maingot's Abdominal Operations
What’s inside
6 sections · 161 slides
Overview
- Scope of this topic
- Two separate diseases in one region
- Roadmap of the topic
Gallbladder Cancer: The Disease
Who develops it, what it looks like under the microscope, and how it is staged
- Incidence of gallbladder cancer
- Geographic distribution
- Gallstones as the principal risk factor
- Recognised risk factors for gallbladder cancer
- Porcelain gallbladder and gallbladder polyps
- Chronic infection and carcinogen exposure
- Abnormal pancreaticobiliary duct junction
- Features of cancers arising with APBDJ
- Sequence of malignant transformation
- Pathogenesis of gallbladder cancer
- Molecular changes in gallbladder cancer
- Histological types of gallbladder cancer
- Morphological growth patterns
- Prognostic value of growth pattern
- Staging systems for gallbladder cancer
- Node categories in the seventh edition
- Stage group revisions in the seventh edition
- TNM stage groups for gallbladder cancer
- Depth of invasion in the T categories
- Symptoms of early gallbladder cancer
- Features of advanced gallbladder cancer
- Laboratory tests and tumour markers
- Transabdominal ultrasonography
- Ultrasound appearance of gallbladder cancer
- What to notice on the ultrasound images
- Endoscopic ultrasonography
- Computed tomography in gallbladder cancer
- CT appearance of gallbladder cancer invading the liver
- Magnetic resonance imaging and cholangiography
Gallbladder Cancer: Treatment
Stage-directed resection, operative technique, palliation and outcomes
- Role of surgical resection
- Indications and contraindications for preoperative biopsy
- Stages 0 and I: Tis and T1a disease
- Management of incidentally discovered early cancer
- Management of a positive cystic duct margin
- Management of T1b gallbladder cancer
- Rationale for re-exploration in T2 disease
- Extent of re-exploration for T2 disease
- Re-excision of previous wound and port sites
- Planned resection for suspected T2 disease
- Choice of liver resection for T2 disease
- Stage III gallbladder cancer
- Extent of resection in T3 disease
- Stage IV gallbladder cancer
- Operation matched to T stage
- Staging laparoscopy before laparotomy
- Avoidance of laparoscopic cholecystectomy in suspected cancer
- Incision and exploration
- Intraoperative frozen-section decisions
- Kocher manoeuvre and nodal assessment
- Regional lymphadenectomy
- Common duct resection
- En bloc liver resection
- Avoiding injury to the right hepatic artery
- Operative field after radical cholecystectomy
- What the resection illustration shows
- Biliary reconstruction after common duct resection
- Adjuvant therapy after resection
- Goals of palliation in gallbladder cancer
- CT of advanced gallbladder cancer with a biliary stent
- Wallstent placed for obstructive jaundice
- What the stent images demonstrate
- Non-surgical treatment of advanced disease
- Population-based survival in gallbladder cancer
- Survival in contemporary surgical series
- Morbidity and mortality of resection
- 11.7 mo
Bile Duct Cancer: The Disease
Cholangiocarcinoma - risk factors, anatomical classification, staging and diagnosis
- Definition of cholangiocarcinoma
- Incidence and demographics
- Primary sclerosing cholangitis
- Recognised risk factors for bile duct cancer
- Liver flukes and hepatolithiasis
- Congenital, chemical and occupational risks
- Genetic conditions predisposing to bile duct cancer
- Molecular pathogenesis in bile duct epithelium
- Histological types of bile duct cancer
- Growth patterns of cholangiocarcinoma
- Resectability by growth pattern
- Anatomical classification of cholangiocarcinoma
- Sites of origin and their frequencies
- Bismuth classification of perihilar bile duct cancers
- Bismuth types by level of duct involvement
- Purpose of the Bismuth classification
- Separate staging systems in the seventh edition
- TNM stage groups for intrahepatic bile duct cancer
- TNM stage groups for perihilar bile duct cancer
- TNM stage groups for distal bile duct cancer
- Reading the three staging tables together
- Presentation of intrahepatic cholangiocarcinoma
- Presentation of extrahepatic cholangiocarcinoma
- Differential diagnosis
- Laboratory findings and tumour markers
- Ultrasonography and computed tomography
- CT appearance of intrahepatic cholangiocarcinoma
- Indirect CT signs of perihilar tumours
- CT findings in distal bile duct cancer
- Staging information from the CT scan
- Atrophy-hypertrophy complex
- Determining proximal and distal tumour extent
- ERCP appearance of a hilar cholangiocarcinoma
- What the cholangiogram shows
- Magnetic resonance cholangiopancreatography
- Positron emission tomography and biopsy
- Dominant biliary stricture in primary sclerosing cholangitis
- Endoscopic ultrasound-guided fine-needle aspiration
Bile Duct Cancer: Treatment
Resectability, the perihilar operation step by step, palliation and outcomes
- Role of resection in cholangiocarcinoma
- Patient and disease contraindications to resection
- Anatomical contraindications to resection
- Preoperative biliary stenting for distal tumours
- Preoperative drainage for perihilar tumours
- Operation matched to tumour location
- Staging laparoscopy in cholangiocarcinoma
- Laparotomy and nodal assessment
- Lowering the hilar plate
- Sagittal section through the hilar plate
- Orientation to the hilar plate illustration
- Mobilisation of the extrahepatic biliary tree
- Dissection of the biliary tree off the portal vein
- Use of traction during the dissection
- Dissection at the hepatic duct bifurcation
- Transection of the right and left hepatic ducts
- Skeletonized hepatoduodenal ligament after resection
- Margin assessment after resection
- Reconstruction after resection of a Klatskin tumour
- Technique of biliary catheter exchange
- Exchange of Ring catheters for Silastic catheters
- Construction of the biliary-enteric anastomoses
- Posterior row of the bilateral hepaticojejunostomies
- Operative field after completed reconstruction
- Fixation of the Roux limb and catheter marking
- Steps of the perihilar resection
- Addition of hepatic resection
- Resection specimen from an extended hilar resection
- Preoperative portal vein embolization
- Liver transplantation for cholangiocarcinoma
- Adjuvant and neoadjuvant therapy
- Principles of palliation in bile duct cancer
- Choice of stenting route
- Number of stents in hilar obstruction
- Metal and plastic biliary stents
- Prophylactic cholecystectomy at laparoscopy
- Surgical bypass for unresectable disease found at laparotomy
- Palliative options for unresectable perihilar tumours
- Technique of segmental duct bypass
- Surgical approach to the segment 3 duct
- Radiotherapy in advanced bile duct cancer
- Systemic chemotherapy for advanced bile duct cancer
- Photodynamic therapy
- Outcomes in perihilar cholangiocarcinoma
- Outcomes in intrahepatic and distal cholangiocarcinoma
- 11.7 mo
Summary
What to carry away from gallbladder and bile duct cancer
- Key points: gallbladder cancer
- Key points: bile duct cancer
- Shared principles across biliary tract cancer
- References
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition