Current status in the management of proximal bile duct carcinoma.

The confluence of the biliary duct constitutes the most common location of the bile duct neoplasms. Resection of the tumor is the only procedure which has met with long-term survival rates (more than 5 years). An enhanced exposure of the tumor in surgical intervention contributes to increasing the number of resectable cases. The transhepatic approach through the principal incision offers the best possibility to explore the tumors of the proximal bile duct confluence, using this approach the resection rate is higher than that of other routes. The surgical management of confluence biliary duct carcinoma can be curative if the diagnosis is made in early stages of the disease and if at that time resection is possible.