Radical resection of biliary tract cancers and the role of extended lymphadenectomy.

Extended hemihepatectomy and/or pancreatoduodenectomy plus extrahepatic bile duct resection and an extended lymphadenectomy of up to the group 2 lymph nodes can enable long-term survival in patients with extrahepatic bile duct (EBD) cancer with acceptable surgical risks. Surgeons should dissect and examine at least 10 or more nodes in curative intent surgeries for local disease control and accurate staging. Radical surgical procedures for EBD cancer, including a right lobectomy, left trisectoriectomy, hepatopancreatoduodenectomy, and combined vascular resection and reconstruction, are useful options for obtaining a negative margin, but the benefits of such procedures to long-term survival rates is limited to selected patients without nodal metastasis and with negative surgical margins.