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Gallbladder malignancies are rare tumors, often affecting adjacent liver tissue or the hepatic hilus. Its radical treatment often involves aggressive surgical approach in which surgical skills, preoperative diagnosis and the latest technical advances are necessary.

Cholangiocarcinoma

Malignancies arising from the bile ducts, both intrahepatic or extrahepatic, are a common cause of obstructive jaundice. Its radical approach involve aggressive surgery, sometimes after neoadjuvant radiotherapy and/or chemotherapy. Clinically, it can be seen in the presence of jaundice, abdominal pain, fever, nausea and vomits. In many cases, the symptoms of the patients that suffer from this tumoral process can be mistaken for benign biliary pathologies. An early diagnose is not frequent due to the lack of noticeable symptoms at early stages of this illness.

Gallbladder cancer. s very uncommon among the possible tumors in the digestive apparatus. Clinically, gallbladder cancer can be seen in the presence of jaundice, abdominal pain, fever, nausea and vomits. In many cases, the symptoms of the gallbladder cancer patients that suffer from this tumoral process can be mistaken for benign biliary pathologies. An early diagnose is not frequent due to the lack of noticeable symptoms at early stages of this illness.

The diagnostic tests performed in our Hospital for diagnosing gallbladder cancer are orientated towards the diagnosis of the tumoral process (ultrasound and helical computed tomography)and discerning its local extension (helical computed tomography, laparoscopic ultrasonography, ecoendoscopy, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography), and the possible dissemination (PET-CT and chest-abdominal axial tomography). After all these tests, we can establish the staging of the der cancer, which affects the treatment to follow. In stages I, II and III, better results in terms of survival are obtained through radical surgery with practices such as cholecystectomy (related to liver resection), extended lymphadenectomy and, sometimes, biliary tree resection.

The aim of this surgical treatment is to perform a complete resection of the tumor with free margins. Even if this result is achieved with patients of gallbladder cancer in stages II and III, it is advisable to follow postoperative chemotherapy.

Biliary tree tumors are classified depending on their location: distal, medial and proximal biliary duct in the corresponding area of the confluence of the left and right hepatic bile ducts (Klatskin tumor).

The diagnostic explorations are similar to those described for patients with biliary tree carcinoma. It is necessary to obtain through these explorations an extension of the tumoral process in the biliary tree, as well as the probable vascular involvement. A surgical treatment is the chosen procedure for patients without tumoral dissemination; in our Hospital, this treatment is performed after neoadjuvant chemotherapy. The surgical technique will depend on the location of the tumor. With injuries located in the distal biliary tree, it is necessary to proceed with a cephalic duodenopancreatectomy. In case of those located in the medial area of the biliary tree, the best option is resecting it with wide oncologic margins. With injuries in the proximal section, the preferred option is resecting the tumoral duct with a wide liver resection (left, right or central hepatectomy). A liver transplant is recommended in very limited cases without tumoral dissemination in which a surgical resection is not possible.

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