Multimodal treatment strategies for advanced hilar cholangiocarcinoma

Cholangiocarcinoma (CCA) is the second most common primary malignancy of the liver arising from malignant transformation and growth of biliary ductal epithelium. Approximately 50–70 % of CCAs arise at the hilar plate of the biliary tree, which are termed hilar cholangiocarcinoma (HC). Various stagin...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2014-08, Vol.399 (6), p.679-692
Main Authors: Weiss, Matthew J., Cosgrove, David, Herman, Joseph M., Rastegar, Neda, Kamel, Ihab, Pawlik, Timothy M.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Antineoplastic Agents - therapeutic use
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - therapy
Bile Ducts, Intrahepatic
Cardiac Surgery
Cholangiocarcinoma - mortality
Cholangiocarcinoma - pathology
Cholangiocarcinoma - therapy
Combined Modality Therapy - methods
General Surgery
Hepatectomy
Humans
Liver Transplantation
Medicine
Medicine & Public Health
Review Article
Thoracic Surgery
Traumatic Surgery
Treatment Outcome
Tumor Burden
Vascular Surgery
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Summary:Cholangiocarcinoma (CCA) is the second most common primary malignancy of the liver arising from malignant transformation and growth of biliary ductal epithelium. Approximately 50–70 % of CCAs arise at the hilar plate of the biliary tree, which are termed hilar cholangiocarcinoma (HC). Various staging systems are currently employed to classify HCs and determine resectability. Depending on the pre-operative staging, the mainstays of treatment include surgery, chemotherapy, radiation therapy, and photodynamic therapy. Surgical resection offers the only chance for cure of HC and achieving an R0 resection has demonstrated improved overall survival. However, obtaining longitudinal and radial surgical margins that are free of tumor can be difficult and frequently requires extensive resections, particularly for advanced HCs. Pre-operative interventions may be necessary to prepare patients for major hepatic resections, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and portal vein embolization. Multimodal therapy that combines chemotherapy with external beam radiation, stereotactic body radiation therapy, bile duct brachytherapy, and/or photodynamic therapy are all possible strategies for advanced HC prior to resection. Orthotopic liver transplantation is another therapeutic option that can achieve complete extirpation of locally advanced HC in judiciously selected patients following standardized neoadjuvant protocols.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-014-1219-1