Bile Duct Cancer: Surgery

Surgery is often the first choice to treat bile duct cancer. The goal is to remove all the cancer. It is the only treatment that may cure people whose bile duct cancer has not spread.

In people whose cancer has spread, surgery may be done to help relieve symptoms. This may be the case for cancer that can’t be fully removed. This is called palliative surgery. It can help relieve pain and prevent complications.

Types of surgery for bile duct cancer

The type of surgery your doctor chooses depends on where the cancer is and how far it has spread. Your doctor will also look at your age, overall health, and medical history.  Here are some surgical options for bile duct cancer: 

• Removal of the bile duct. A small tumor that is only in the bile duct close to where it first comes out of the liver, is called perihilar bile duct cancer. For this cancer, a surgeon may remove the entire bile duct. The surgeon will make a new connection to the small intestine. This lets the bile flow again. If the cancer has spread to nearby tissues, most often the liver, the surgeon may need to remove some of that tissue as well. The surgeon may also take out nearby lymph nodes and check them for signs of cancer.

• Partial hepatectomy. This is also called liver resection. For this surgery, the surgeon removes the part of the liver where the intrahepatic bile duct cancer is found. The cancer is in a bile duct that's inside the liver. This surgery may also be done if cancer is in the hepatic duct very close to the liver. A large or small part of the liver may be removed. The surgeon may also remove some nearby normal tissue to be sure that all the cancer is taken out.

• Whipple procedure. This is also called pancreaticoduodenectomy. If the bile duct cancer is in the part of the duct that's very close to the pancreas, you may need this surgery. For this procedure, the surgeon takes out the bile duct and the gallbladder, along with part of the pancreas, part of the stomach, and the first part of the small intestine. 

• Surgical biliary bypass. If the surgeon can’t fully remove the cancer, he or she may do a bypass. This helps lessen symptoms caused by the cancer. For example, if the cancer is blocking the bile ducts and bile builds up, surgery can help relieve the blockage. The surgeon will connect the bile duct to a piece of the small intestine. This creates a new pathway around the blockage. It lets the bile flow to your intestine for normal digestion of fats. This is a type of palliative surgery. It doesn’t cure the cancer. But it can relieve jaundice and other symptoms. 

• Liver transplant. Liver transplant may help some patients if the cancer is in the liver. The liver and bile ducts are removed, and a donor liver is put in. This is a major, complex surgery. But in some people it may cure the cancer. 

• Stent or catheter placement. If the tumor is blocking the bile duct, a short, thin tube (stent) may be placed in the duct to keep it open. Or a long, flexible tube (catheter) may be put in to drain bile outside of the body. The doctor may place the stent or catheter during surgery. This is a type of palliative surgery. It’s done to prevent or relieve jaundice, pain, and other problems.

Questions to ask your doctor

Here are some questions you may want to ask your doctor about surgery for bile duct cancer:

• What kind of surgery can I consider?

• What option do you recommend for me?

• How many times have you done this surgery?

• Are there any other treatment options besides surgery? 

• What will happen if I don't have the surgery? 

• Will it cure me of the cancer?

• How will I feel after surgery?

• Will I need radiation and chemotherapy before or after surgery?

• Where will the scars be? What will they look like?

• When can I get back to my normal activities?

• How will surgery affect my diet?

• What kind of follow-up care will I need after surgery?

• Will I need other treatment after surgery?

The types of surgeries used to treat bile duct cancer are very complex, and you want a skilled surgeon with experience. Be sure you understand the goal of the surgery. It takes a long time to recover after some of these procedures. Talk with your doctor about the risks and benefits, as well as how surgery might affect your life.

What to expect after surgery

Surgery for bile duct cancer can have major side effects. Make sure to compare the risks of surgery to how surgery might help you. Possible side effects of surgery include:

• Infection at the incision site

• Poor wound healing

• Pain

• Blood clots

• Leakage at the bile drainage site

• Nausea or vomiting

• Problems with digestion and nutrition

• Liver problems