Cholangiocarcinoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] Suveenkrishna Pothuru, M.B,B.S. [3]

Overview[edit | edit source]

The mainstay of treatment for cholangiocarcinoma is surgical resection. Surgical resection of tumors with negative margins is the best option for all subtypes of cholangiocarcinoma.

Surgery[edit | edit source]

• Surgical exploration may be needed to obtain a suitable biopsy and to accurately stage a patient with cholangiocarcinoma.
• Laparoscopy can be used for staging purposes and may avoid the need for a more invasive surgical procedure, such as laparotomy.^[1][2]
• Routine lymphadenectomy at the time of surgical resection has been recommended to increase the chance of survival. Although it can be omitted in patients with solitary, small peripheral cholangiocarcinoma because of the low risk of metastasis.
• Surgical resection is not recommended for cholangiocarcinomas in patients with primary sclerosing cholangitis because the recurrence rate is very high.

Intrahepatic cholangiocarcinomas[edit | edit source]

• In intrahepatic cholangiocarcinomas, resection has usually been reserved among patients with a solitary tumor and with no underlying hepatic disease.^[3]

Extrahepatic cholangiocarcinomas[edit | edit source]

• Resection is an appropriate treatment, depending on the extent in the biliary tree and hepatic vasculature.^[4]
• Resection is usually reserved for extrahepatic cholangiocarcinomas which is restricted to one lobe and without metastasis and abnormal liver function.^[5]
• Tumor ablation performed percutaneously with sonographic guidance using radiofrequency or microwave energy is usually reserved for nonoperable tumors up to 5 cm in size.

Biliary Stent[edit | edit source]

• Biliary stent is usually reserved for patients with non-operable cholangiocarcinoma.^[6]
• It is performed percutaneously.
• Plastic stents require to be changed every 3 months and metal stents could be maintained for longer times.
• Metal stents are preferred rather than plastic stents because of rapid biliary decompression and a low complication rate after insertion.

Liver Transplant[edit | edit source]

• Liver transplantation is usually reserved for patients with cholangiocarcioma with either:^[7][8]
  • Perihilar cholangiocarcinoma in the early stages, which cannot be removed surgically
  • No detected metastase
  • Tumors developed in liver with reduced function or underlying a biliary inflammation pathology, such as primary sclerosing cholangitis.

References[edit | edit source]

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