Advances in the surgical treatment of hilar cholangiocarcinoma

Abstract

With the improvement of perioperative management and surgical techniques as well as the accumulation of knowledge on the oncobiological behavior of bile duct carcinoma, the long-term prognosis of hilar cholangiocarcinoma has been improving. In this article, the authors review the recent developments in surgical strategies for hilar cholangiocarcinoma, focusing on diagnosis for characteristic disease extension, perioperative management to reduce postoperative morbidity and mortality, surgical techniques for extended curative resection and postoperative adjuvant therapy.

Keywords:

• bile duct drainage
• hilar cholangiocarcinoma
• percutaneous transhepatic portal embolization
• perioperative management
• residual liver function
• superficial spreading biliary cancer
• surgical strategy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Hilar cholangiocarcinoma is a relatively rare disease, accounting for approximately 2% of all malignancies.

• Bile duct carcinoma usually progresses vertically and longitudinally in the bile duct. Superficial in situ disease extension is one of the characteristic forms of disease progression that extends inside the bile duct more than 2 cm.

• Endoscopic nasobiliary drainage for the future remnant liver has been reported as an advantageous initial method for preoperative bile duct drainage.

• The surgical procedures can be chosen depending on disease location and laterality of the bile duct bifurcation from bile duct resection alone, bile duct resection combined with hemihepatectomy and trisectionectomy.

• Due to its relatively slow-growing characteristics, concomitant portal vein resection or arterial resection and reconstruction have been applied in selected cases.

• Although the outcome of the surgical treatment is still improving and challenging, relatively high survival rate could be expected in cases where R0 resection has been performed. Cumulative overall survival has been reported to range from 10 to 40%, of them it ranged from 29 to 47% in the R0 resection cases.