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Surgical management, including the role of transplantation, for intrahepatic and peri-hilar cholangiocarcinoma

Lookup NU author(s): Abdullah Malik, Professor Derek Manas


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© 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical OncologyIntrahepatic and peri-hilar cholangiocarcinoma are life threatening disease with poor outcomes despite optimal treatment currently available (5-year overall survival following resection 20-35%, and <10% cured at 10-years post resection). The insidious onset makes diagnosis difficult, the majority do not have a resection option and the high recurrence rate post-resection suggests that occult metastatic disease is frequently present. Advances in perioperative management, such as ipsilateral portal vein (and hepatic vein) embolisation methods to increase the future liver remnant volume, genomic profiling, and (neo)adjuvant therapies demonstrate great potential in improving outcomes. However multiple areas of controversy exist. Surgical resection rate and outcomes vary between centres with no global consensus on how ‘resectable’ disease is defined – molecular profiling and genomic analysis could potentially identify patients unlikely to benefit from resection or likely to benefit from targeted therapies. FDG-PET scanning has also improved the ability to detect metastatic disease preoperatively and avoid futile resection. However tumours frequently invade major vasculo-biliary structures, with resection and reconstruction associated with significant morbidity and mortality even in specialist centres. Liver transplantation has been investigated for very selected patients for the last decade and yet the selection algorithm, surgical approach and both value of both neoadjuvant and adjuvant therapies remain to be clarified. In this review, we discuss the contemporary management of intrahepatic and peri-hilar cholangiocarcinoma.

Publication metadata

Author(s): Malik AK, Davidson BR, Manas DM

Publication type: Article

Publication status: Published

Journal: European Journal of Surgical Oncology

Year: 2024

Pages: epub ahead of print

Online publication date: 06/03/2024

Acceptance date: 03/03/2024

ISSN (print): 0748-7983

ISSN (electronic): 1532-2157

Publisher: W.B. Saunders Ltd


DOI: 10.1016/j.ejso.2024.108248


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