There are several types of surgery for bile duct cancer, which are meant to cure cancer or to manage its symptoms.
Your bile ducts transport bile from the liver and the gallbladder to the small intestine to help your body digest fats. Bile duct cancer, also known as cholangiocarcinoma, is a rare form of cancer that begins in the bile ducts.
Here we cover surgical treatment options for bile duct cancer. We discuss surgery types and purposes of each type, effectiveness, side effects and risks, costs, and other important topics.
There are two main types of bile duct cancer surgery: curative and palliative.
The purpose of
There are several kinds of curative and palliative surgeries for bile duct cancer. Let’s explore them in more detail.
Curative surgery is a complex procedure, and doctors sometimes differ in their opinion on when this potentially curative approach should be considered. The
Bile duct resection
This surgery aims to cure cancers that affect bile ducts outside the liver. A surgeon will first remove the affected bile duct and then make a new one by connecting the remaining bile duct to the intestine.
This procedure involves the removal of a portion of the liver along with the affected bile ducts. It’s performed on bile ducts that are inside the liver.
This procedure is more extensive than partial hepatectomy. It’s used for cancers that have spread inside the liver. It involves removing the whole lobe (right or left part) of your liver.
The Whipple procedure is also called a pancreaticoduodenectomy. It’s used for tumors that are near the pancreas and small intestine. It’s a complex procedure that involves removing the affected bile duct, the nearby lymph nodes, and parts of the pancreas and small intestine.
If your cancer has spread too much inside your liver or if it’s difficult to reach, a doctor may recommend completely removing the liver and bile ducts and getting a liver transplant. It can potentially cure the cancer, but it may be hard to find a cancer center that accepts people with bile duct cancer into their transplantation program.
Doctors perform palliative surgery to relieve symptoms or treat complications, such as blockage of the bile ducts.
Biliary bypass is a surgical procedure that creates a new pathway for bile to flow when the tumor is blocking the bile ducts (bile duct obstruction). This allows bile to bypass the blockage and enter the small intestine, relieving symptoms like jaundice and pain.
Biliary stent or biliary catheter
Stent or catheter placement can be done when biliary bypass isn’t possible. A surgeon will instead put a small tube into the duct to help keep it open.
A stent is a metal or plastic tube that goes through the blockage in the duct. A catheter is a flexible tube, one end of which is connected to a bile duct and the other end of which is in the drainage bag outside of your body.
The effectiveness of bile duct surgery depends on the procedure, the type of cancer and its stage, and your overall health.
Curative surgeries are complex procedures that are only effective in early stage tumors. Palliative surgeries are usually effective in relieving symptoms in most people.
Let’s talk about what happens before, during, and after both curative and palliative bile duct cancer surgeries.
Before the surgery
If the doctor is considering curative surgery, they may do a laparoscopy before the main procedure. It’s a minimally invasive surgery that helps surgeons see how far your cancer has spread and plan the main surgery.
For both curative and palliative surgeries, you’ll likely have a presurgery appointment to help prepare for the procedure. A doctor or a nurse can perform several tests to plan your care, which could include, for example:
The surgeon will also tell you which medications to take and to avoid before the surgery. You’ll likely need to follow a clear liquid diet for at least a day before the procedure and avoid both eating and drinking on the day. There may be other preparations needed as well.
During the surgery
You’ll be under general anesthesia during the procedure. Once you’re fully asleep, the medical team will insert a breathing tube through your mouth and into your windpipe to help you breathe. They’ll also put compression boots on your lower legs to help your blood flow.
Depending on the complexity of the procedure, the surgery can take anywhere from 2–5 hours. During this time, a surgeon will perform incisions to remove parts of the affected organs or restore bile flow.
After the surgery
You’ll likely wake up in the recovery room. According to Cancer Research UK, you may notice several tubes connected to your body, which could include, for example:
- an intravenous (IV) line to give you fluids
- a biliary drainage catheter to drain bile
- a tube down your nose into your stomach that drains stomach fluids
- a pump that delivers pain medication into your spinal fluid
- a catheter into your bladder to measure how much urine you pass
After some time in the recovery room, the healthcare team will transfer you to your hospital room.
Bile duct cancer surgery, especially the curative type, is a major operation that may require around a week in the hospital to recover. Let’s go over a few things to keep in mind as you recover after the surgery.
You’ll need to move as much as possible to prevent blood clots and stimulate your bowels. Someone from the medical team will help you get up and walk every couple of hours until you’re able to walk on your own.
You won’t be able to eat or drink for a day or two after the surgery. You’ll then start on a clear liquid diet. With a doctor’s approval, you’ll eventually go back to your usual diet.
Many people lose weight before surgery. You’ll regain your weight slowly as your appetite improves.
You may have pain at the sites of incisions. This is normal, and the medical team will give you pain medications. Be sure to let them know if you still feel pain. They might need some time to find the right type and dose for you. It’s important to manage your pain to help recovery.
Before you go home, a doctor or nurse will give you prescriptions for medications. They’ll also give you advice on home care, such as how to care for your wounds and what diet to follow.
You’ll have a follow-up appointment 10–14 days after you go home. Be sure to contact the medical team if you have any difficulties or symptoms you’re unsure about.
The side effects and risks of the surgery depend on the extent of the procedure and your overall health. Some potential issues after bile duct cancer surgery involve:
Curative surgeries can only be done on resectable tumors. “Resectable” means a tumor can be completely removed from your body. Only a small percentage of bile duct cancers are resectable.
Palliative surgery, on the other hand, can be performed on more advanced tumors. It can be helpful if you have bile duct blockage.
Bile duct cancer 5-year survival rates vary between
However, if your cancer is cured after the surgery, your outlook will be much better. Be sure to ask a doctor about your individual outlook.
Bile duct cancer surgery is a costly procedure. The total cost will vary significantly depending on the type of surgery and the extent to which tumors have spread. According to
Medicare covers some types of bile duct cancer surgery including hepatectomy. Be sure to check with your insurance provider to find out what types of procedures are covered.
Surgery is one of the treatment options for bile duct cancers. Surgery may be curative (for early stage cancers) or palliative (to treat complications). Bile duct surgery is a major procedure that requires extensive preparation and a long recovery. Be sure to speak with a doctor to find out if you’re a candidate.