Editing Cholangiocarcinoma (section)

== '''Management prior to tissue diagnosis''' ==

* Tissue is not necessary prior to resection (bile cytology and brushings are unreliable with obstructive jaundice anyway, with poor sensitivity)
* No need to continue with invasive attempts to establish a diagnosis prior to resection, as it does not alter management
* 7-15% undergoing resection for suspected biliary malignancy will be found to have benign disease on formal histology
* Tissue diagnosis is only important when the patient is not a surgical candidate
* Pre-operative biliary drainage may be useful in select cases; but decision needs to be made with HPB involvement, because you risk seeding bacteria into an area of the liver you might not be able to drain in the future, leading to problems with recurrent cholangitis. The converse opinion is that you improve nutrition and liver function.
** Distal cholangiocarcinoma with bilirubin > 171micromol/L
** Prolonged interval between diagnosis and resection
** Hilar cholangiocarcinoma with complete biliary obstruction - drain obstructed but unaffected segments to enhance post-resection hypertrophy, despite higher risk of peri-operative infectious complications