Proximal Extrahepatic Bile Duct Cancer Resection

• bile duct segment - site: common bile duct/common hepatic duct/right or left hepatic duct/ cystic duct.

- dilated/ulcerated/strictured/cyst and maximum dimension (cm) of lesion.

- calculi.

- site: common bile duct/common hepatic duct/right or left hepatic duct/cystic duct/ intraduct/mural/extramural/involvement of liver.

- appearance: strictured/ulcerated/nodular/polypoid.

- dimensions (cm) and maximum dimension (cm) of tumour present.

• biliary stent - not present/present/placement (within or outside the lumen).

• gall bladder - present/not present/involved by tumour.

• sample the distal bile duct limit (circumferential transverse section) and the proximal bile duct limit or the hepatic resection margin (two or three blocks).

• paint the external adventitial CRM.

• serially section the specimen transversely at 3-4 mm intervals.

• sample five or six blocks to demonstrate the worst point of tumour invasion in relation to the CRM, liver, gall bladder, proximal and distal surgical limits.

• sample all lymph nodes.

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