1. بسم الله الرحمن الرحيم

3. CHOLANGIOCARCINOMA Is the second most frequent malignant tumor of the liver after hepatocelular carcinoma, with incidence at autopsy ranges from 0.01 to 0.05%

9. Lygidakis 1989

14. Left hepatectomy, segment one resection Portal. V. I.V.C. R.hepatic A.

15. CCC supra duodenal dissection

24. MRCP of young patients with C.C.C

25. MRCP. Shows Hilar chalangio carcinoma CCC

30. Operative photo : stent inside the common hepatic duct of C.C.C

32. Cholangio carcinoma in cirrhotic liver

39. Operative photo loclaised resection in cirrhotic liver

40. RA RP LD CHD GB Localized resection of C.C.C

41. Post operativ cholangiography after resection of central cholangiocarcinoma double hapaticojejunostomy(arrows)

44. Operative photo of C.C.C (atrophic left lob)

46. Portography (obstruction of the left portal vein)

47. Operative cholangiogram

48. CCC supra duodenal dissection Segment 1 abscess CCC portahepatis dissection

49. Left hepatectomy, segment one resection Cut surface after left hepatectomy (catheters inside 3 ducts)

50. 1 2 3 4

51. Papillematosis of the left hepatic duct

53. Left hepatectomy + segment I for C.C.C

55. Left hepatectomy for C.C.C in cirrhotic liver

56. Post operative cholangiogram right hepatico jujnostomy after left hepatectomy for C.C.C

57. Post operative cholangiogram after left hepatectomy

58. Cholangogram after left hepatectomy for hillar chalongio carcinoma Right hepatico jejunostomy (arrow) CCC

63. Hepatic Vein Dissection

65. Dessection of Rt Hepatic Vein Rt H V Occlusion 15 S

66. 1 2 3 4

67. One week . Postoperative Chalangiogrphy ( left hepaticojejunostomy)

68. Post operative cholangiogram after right hepatectomy for C.C.C

70. postoperative complication Total BDR. (20) BDR+L.R . (26) Internal haemonhage 2 - 2 (4.3) Wound infection 4 2 (10) 2 (7.6) Multiple organfailure 1 - 1 (3.8) Pulmonary infarction 1 1 (5) - Total No. with comp. 13 4 (20) 9 (34.6) continue

71. Hospital Mortality 5 (10.8) Causes No. % Hepatic cell failure 3 6.6 Gastro intestinal bleeding 1 2.1 Multple organ failure 1 2.1

75. Surgery for recurrent CCC anastomotic

76. Surgery for recurrent CCC

77. CCC

78. 15 months after resection of C.C.C Recurrent stricture (1), Balloon inside stric.(2), After dilatation(3) 1 2 3

85. PTC for pripheral cholangiocarcinoma

86. Time of survival (months) Survival probability

87. Time of survival (months) ( P= 0.017) Survival probability

88. Time of survival (months) (P= 0.041) Survival probability

89. Time of survival (months) ( P= 0.049 ) Survival probability

90. Survival probability Time of survival (months) ( P= 0.25)