Management of Cholangiocarcinomas in Developing Countries. : Report of Seven Cases and Review of Literature.

Background: Cholangiocarcinomas are primary malignant tumours developing from the epithelia of the biliary ducts from the liver to the end of the bile duct in the duodenum. The objective of this review was to share our experience of seven well documented with this condition out of eleven observations treated at the Lusaka University Teaching Hospital (UTH) and point out the impact of palliative surgery played to provide comfortable quality survival.
Methods: This was a ten-year retrospective study all patients operated on at the Lusaka University Teaching Hospital with confirmed diagnostic of cholangiocarcinoma. Seven well documented cases out of eleven treated were considered for this study.
Results: Of the seven patients diagnosed with cholangiocarcinoma, four were males and three were females with ages ranging from 57 to 68 years and mean age of 64 years. At the time of admission, painless obstructive jaundice, with loss of appetite and loss of weight were recorded in 5 of the 7 patients followed by chronic right upper quadrant pain (28.56%). Abdomen Ultrasound and CT Scan were performed only in two patients (28.56%) and the per trans hepatic cholangiogram in one patient(14.48%). Not any histological diagnosis was made pre or intra operatively. The findings and management outcomes are described.
Conclusion: Despite the small number of these tumours (very rare worldwide) but by reviewing literature data, authors noted the severity of the condition related to long standing jaundice and co-morbidities, confirmed the challenge in diagnosis and therapeutic decision making . They encourage reasonable tumour resection and bile diversion as able to procure satisfactory survival as they had many twelve-month survivals after palliative surgery without free margins as expected in world literature. However they continue appealing for more modern medical imaging and histological diagnostic tools in their surgical facilities.

Keywords
Cholangiocarcinoma; Bile ducts; Gall bladder; Bile obstruction; biliary convergence; Surgery