Topic: Is surgery possible in my case?

Diagnosis
Cholangiocarcinoma - PTBD and 2 SEMS placed.
Status post Cholecystectomy
History:
My father had obstructive jaundice. He had undergone cholecystectomy in recent past. On evaluation he had hilar stricture with cholangitis. ERCP and biliary drainage was attempted but in view of narrowed duodenal lumen, scope could not be negotiated till ampula and hence PTBD was done and after initial external drainage, 2 SEMS were placed in the right and left duct. He had ascites and right pleural effusion which were drained. Brush cytology showed high grade dysplasia. His bile culture grew Pseudomonas which were sensitive to Cilastin and Imipenem which he recieved for 10 days.

Is surgery possible in this case?


Investigations Done:

USG Abdomen (24.04.09)
Status post cholecystectomy
Small ill defined hypoechoic mass lesion in the porta hepatic involving the CBD. Mild IHBD in both lobes of liver.
Portal vein thrombosed. Minimal scites.
BPH

MRI - MRCP (24.04.09)
Common hepatic duct, confluence and proximal hepatic ducts stricturous lesions with upstream dilation - ? Neoplastic

Triphase/Dual Phase CT (25.04.09)
1. Post cholecystectomy status.
2. Poorly enhancing ill defined lesion at hilum with Type IV biliary structure and long segment portal vein thrombosis.
3. Minimal Ascites. No lymphadenopathy.
               D/D - ? Chlongiocarcinoma
                        ? Carcinoma Gall Bladder.

Cytology (Ascitic fluid) (29.04.09)
Inflammatory effusion. Negative for malignancy.

Cytology (Balloon) (01.05.09)
Sparsely cellular smear with high grade dysplasia.
Suggested ERCP and radiological correlation.

Re: Is surgery possible in my case?

No doctor has agreed to surgery yet. All doctors I met have concluded that my father's CC is unresectable.

Re: Is surgery possible in my case?

Rosy.....have any other treatment options been offered?
Thinking of you
Marion

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Re: Is surgery possible in my case?

Marions, no other treatment options have been offered yet. The oncologist says its unresectable, and he is also not keen not chemotherapy saying that it doesnt work and that it would make his body further weak.

Re: Is surgery possible in my case?

I would ask why, specifically, the tumor is unresectable.

But Rosy, you just never know.  I was told my tumor was resectable, but when they opened me up they found that the tumor was wrapped around the IVC and they just closed me back up.  The aborted surgery left about an 18" scar on my abdomen.

It's a huge surgery to go through - and can be a long recovery in an older person - so they might not want to risk it if they are not sure.

Best wishes,
Lisa