Perioperative Management of Hilar Cholangiocarcinoma

Abstract

Background: Cholangiocarcinoma is the most common primary tumor of the biliary tract although it accounts for only 2 % of all human malignancies. We herein review hilar cholangiocarcinoma including its risk factors, the main classification systems for tumors, current surgical management of the disease, and the role chemotherapy and liver transplantation may play in selected patients.

Methods: We performed a comprehensive literature search using PubMed, Medline, and the Cochrane library for the period 1980-2015 using the following MeSH terms: "hilar cholangiocarcinoma", "biliary cancer", and "cholangiocarcinoma". Only recent studies that were published in English and in peer reviewed journals were included.

Findings: Hilar cholangiocarcinoma is a disease of advanced age with an unclear etiology, most frequently found in Southeast Asia and relatively rare in Western countries. The best chance of long-term survival and potential cure is surgical resection with negative surgical margins, but many patients are unresectable due to locally advanced or metastatic disease at diagnosis. As a result of recent efforts, new methods of management have been identified for these patients, including preoperative portal vein embolism and biliary drainage, neoadjuvant chemotherapy with subsequent transplantation, and chemoradiation therapy.

Conclusion: Current management of hilar cholangiocarcinoma depends on extent of the tumor at presentation and includes surgical resection, liver transplantation, portal vein embolization, and chemoradiation therapy. Our understanding of hilar cholangiocarcinoma has improved in recent years and further research offers hope to improve the outcome in patients with these rare tumors.

Keywords: Biliary cancer; Hilar cholangiocarcinoma.

Fig. 1. Abdominal CT scan (a) and MRI (b) demonstrating left biliary tree dilatation in a 63-year-old male with hilar cholangiocarcinoma

Fig. 2. ERCP demonstrating mild left and right biliary tree dilatation with non-opacification of the common bile duct due to the presence of a hilar cholangiocarcinoma in a 56-year-old male, prior to stent placement

Fig. 3. Kaplan–Meier Survival for hilar cholangiocarcinoma based upon resection margin (Reprinted from Matsuo)