Surgery for bile duct cancer
Some people are able to have surgery to remove a bile duct cancer.
About surgery for bile duct cancer
You may have surgery to remove bile duct cancer. Or you may have it to help relieve symptoms caused by bile duct cancer blocking the bowel or bile duct.
Surgery to remove the cancer
For some people, surgery to remove bile duct cancer can cure the cancer.
Your surgeon will decide whether they can remove all the cancer based on different tests. If they can remove all the cancer, it is called a resectable cancer.
Surgery for bile duct cancer is a specialised treatment. You will be referred to a specialist centre, where there are surgeons with experience in doing this type of surgery. The type of operation you have will depend on:
- where in the bile ducts the cancer is
- the size of the cancer
- whether it has spread into nearby tissues.
Surgery for bile duct cancer is usually a major operation. This means you need to be well enough to be able to cope with it. Your surgeon will talk about this and discuss the benefits and risks of surgery with you. Together you can decide whether surgery is the right treatment for you.
A liver transplant is not usually an option. It may be offered, but only in rare situations. Your surgeon can discuss this with you.
In a small number of people, bile duct cancer is found at a very early stage. The surgeon removes only the bile ducts containing the cancer. Then they join the remaining ducts in the liver to the small bowel. This allows the bile to flow again.
Most operations for bile duct cancer are much bigger operations and involve removing more tissue.
Types of surgery for bile duct cancer
The operation depends on the type of bile duct cancer you have.
Surgery for intrahepatic bile duct cancer
If you have intrahepatic bile duct cancer, the cancer is in bile ducts in the liver. The surgeon removes the affected part of the liver and the bile ducts.
Surgery for perihilar bile duct cancer
If you have perihilar bile duct cancer, the cancer is where the left and right hepatic ducts meet, just below the liver. The surgeon removes the bile ducts, the gallbladder and the part of the liver close to the bile ducts.
Sometimes the surgeon also removes part of the pancreas and part of the small bowel. This is the same as surgery for distal bile duct cancer.
Surgery for distal bile duct cancer
If you have distal bile duct cancer, the cancer is in bile ducts near the pancreas and small bowel. The surgeon removes the bile ducts, the gallbladder, part of the pancreas and part of the small bowel.
This is a major operation. It is only suitable for people with early-stage distal bile duct cancer. In some people, it may cure the cancer.
You may have 1 of the following operations.
Pylorus-preserving pancreato-duodenectomy (PPPD)
In this operation, the surgeon removes:
- the head of the pancreas
- most of the first part of the small bowel (duodenum)
- the common bile duct
- the gallbladder
- the surrounding lymph nodes.
Pancreato-duodenectomy (Whipple’s operation)
This is like a PPPD operation, but the surgeon removes the lower part of the stomach (the pylorus) as well. It is also called a Whipple’s operation.
Whipple’s operation
The sections in white are the parts removed during a Whipple’s operation.
After a Whipple’s operation
The surgeon attaches the remaining part of the stomach, the remaining bile duct and the tail of the pancreas to the small bowel.
After your operation
You may need to stay in a high-dependency unit (HDU) or intensive care ward straight after the operation. After a few days, you will move to a general surgical ward. Most people need to be in hospital for about 10 days to 3 weeks after these types of operation.
We have more information about recovering after surgery.
After surgery to the pancreas
The pancreas normally produces insulin and digestive juices. If you have had part of the pancreas removed, it will produce smaller amounts of these substances. You may need to have medicines to replace them.
Insulin injections
If you have had part of your pancreas removed, your blood sugar level may not be well controlled. This is because the remaining pancreas may not make enough insulin. You may need to have insulin injections to help control your blood sugar. This is usually only until the remaining pancreas recovers and starts making insulin again.
Digestive juices
The pancreas normally produces digestive juices (enzymes). These help your body break down and absorb fats and protein from your food. If you have had part of your pancreas removed, your body may not be able to absorb nutrients from food. This can cause symptoms such as:
- diarrhoea
- stools (poo) that float, look pale and smell bad
- difficulty putting on weight.
You may need to replace the digestive juices (enzymes) that the pancreas normally makes. This will depend on the type of operation you have had and your ongoing symptoms.
Pancreatic enzyme replacement therapy drugs
You can take capsules that replace the digestive enzymes. You usually take these each time you eat or have a milky drink. Your surgeon, nurse or a dietitian will give you more information about how to take the capsules. You will need to take them for the rest of your life.
Some commonly used enzyme replacement drugs are:
- Creon®
- Nutrizym®
- Pancrease®
- Pancrex®.
The most commonly used is Creon®. Most replacement enzymes are made from pork. There is no alternative that is not pork based. Talk to your healthcare team if you are concerned about this.
Creon® has been approved for use by Jewish people by the Chief Rabbi. The London Central Mosque has said that Muslims may use pork-based medicines if there is no alternative. If you are worried about this, speak to your religious leader.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Vogel, A. et al. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Annals of Oncology. 2022. 34,2; 127-140. Available at: pubmed.ncbi.nlm.nih.gov/36372281/ [accessed March 2023]
Lowe, R.C. et al. Clinical manifestations and diagnosis of cholangiocarcinoma. UpToDate 2023. Available at: www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cholangiocarcinoma [subscription only, accessed March 2023]
Pemigatinib for treating relapsed or refractory advanced cholangiocarcinoma with FGFR2 fusion or rearrangement 2021. National Institute for Health and Care Excellence (NICE). Available at: www.nice.org.uk/guidance/ta722/resources/pemigatinib-for-treating-relapsed-or-refractory-advanced-cholangiocarcinoma-with-fgfr2-fusion-or-rearrangement-pdf-82611190679749 [accessed March 2023]
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