✓ Bengaluru
✓ ZCCK Registered
✓ ZCCK Registered
Dr. Srinivas Bojanapu is an HPB surgeon in Bangalore specialising in the surgical treatment of bile duct cancer (cholangiocarcinoma), including Klatskin tumours, distal bile duct cancers, and intrahepatic cholangiocarcinoma. He provides specialist HPB surgical opinions for patients who have been told their tumour is inoperable.
Cholangiocarcinoma is cancer that arises from the epithelial cells lining the bile ducts — the network of tubes that carry bile from the liver and gallbladder into the small intestine. The bile duct system spans from inside the liver (intrahepatic) through the liver's exit point (the hilum) down to where the bile duct enters the duodenum next to the pancreatic duct.
Bile duct cancer is relatively rare — accounting for approximately 3% of all gastrointestinal cancers globally — but its incidence is rising. In India, it is more common than in Western populations, partly related to biliary parasites, choledochal cysts, and primary sclerosing cholangitis as risk factors.
The critical characteristic of cholangiocarcinoma is that surgery is the only curative treatment. Chemotherapy and radiation can prolong survival in unresectable disease but do not cure. This makes early diagnosis and rapid referral to an HPB specialist who can determine resectability — like Dr. Srinivas Bojanapu in Yelahanka, Bangalore — essential to giving patients the best chance of cure.
Arises from bile duct cells within the liver substance. Often presents as a liver mass on imaging and can be confused with hepatocellular carcinoma (HCC). Typically requires liver resection (hepatectomy).
Located at the liver hilum where the left and right bile ducts meet. The most common and most surgically complex type. Requires bile duct resection combined with partial liver resection in most cases. Classified by Bismuth-Corlette staging (I–IV) to plan surgery.
Arises in the lower common bile duct near the pancreas and duodenum. The most favourable subtype for surgical cure. Treated with the Whipple procedure (pancreaticoduodenectomy), the same operation used for pancreatic head cancers.
The most frequent first symptom is painless obstructive jaundice — jaundice that appears without severe pain, caused by tumour blockage of the bile duct. This causes a distinctive pattern: yellow skin and eyes, dark tea-coloured urine, pale clay-coloured stools, and intense skin itching as bile salts accumulate in the bloodstream.
Because these symptoms often appear only when the tumour has grown large enough to block bile flow, many patients present with locally advanced or even metastatic disease. Any new-onset painless jaundice in an adult must be investigated urgently — within days, not weeks.
A rising CA 19-9 in a patient with known primary sclerosing cholangitis (PSC) or biliary disease should also prompt urgent imaging and HPB specialist review.
Most cholangiocarcinoma occurs without an identifiable risk factor. However, several conditions significantly increase risk:
Accurate staging of cholangiocarcinoma determines whether surgery is possible and which operation is needed. Dr. Srinivas reviews all imaging personally before planning surgery.
Only surgery achieves cure. The operation is tailored to the location and extent of the tumour.
En-bloc removal of the bile duct confluence, regional lymph nodes, and partial liver (right or left hepatectomy depending on tumour extent). The biliary tract is reconstructed with a hepatico-jejunostomy. Caudate lobe (segment 1) is typically included as it drains directly to the hilum.
The standard operation for distal bile duct cancer. Removes the lower bile duct along with the pancreatic head, duodenum, and regional lymph nodes. The same operation performed for pancreatic head cancers. Reconstruction involves three bowel anastomoses.
Intrahepatic cholangiocarcinoma is treated like other liver tumours — by resecting the involved liver segment or lobe with adequate margins. Laparoscopic liver resection is possible for tumours in accessible segments with faster recovery.
For patients with unresectable disease causing obstructive jaundice, biliary drainage (endoscopic stenting, PTBD, or surgical bypass) relieves symptoms and enables chemotherapy. Metal stents provide longer patency than plastic stents for malignant biliary obstruction.
DrNB Surgical Gastroenterology (Sir Ganga Ram Hospital, Delhi) + PDF Liver Transplant & HPB Surgery (RGUHS). Specific training in complex biliary reconstruction including Klatskin tumour resection.
Every cholangiocarcinoma case reviewed in a multidisciplinary team with oncologists, radiologists, and hepatologists before surgery. No solo decisions on complex cases.
Access to full HPB support: interventional radiology (PTBD, portal vein embolisation), ERCP, oncology, and ICU at Kauvery Hospital, Electronic City.
Told your Klatskin tumour is inoperable? Dr. Srinivas reviews these cases specifically. Extended resections including en-bloc liver resection may achieve R0 where lesser operations cannot.
Dhaara Liver Clinic in Yelahanka for outpatient review — no need to travel to distant city-centre hospitals for North Bangalore and Airport Road corridor patients.
Adjuvant chemotherapy referral post-resection (BILCAP protocol, capecitabine). Molecular testing (FGFR2, IDH1) organised for patients with unresectable disease.