Page 37 - Read Online

Hewitt et al. Hepatoma Res 2021;7:75 Hepatoma Research
DOI: 10.20517/2394-5079.2021.83

Review Open Access

Surgical management of cholangiocarcinoma

D. Brock Hewitt, Zachary J. Brown, Timothy M. Pawlik

Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH 44455, USA.
Correspondence to: Dr. Timothy M. Pawlik, Department of Surgery, The Ohio State Wexner Medical Center, 395 W. 12th Ave.,
Suite 670, Columbus, OH 44455, USA. E-mail: Tim.Pawlik@osumc.edu

How to cite this article: Hewitt DB, Brown ZJ, Pawlik TM. Surgical management of cholangiocarcinoma. Hepatoma Res 2021;7:75.
https://dx.doi.org/10.20517/2394-5079.2021.83
Received: 23 Jun 2021 First Decision: 9 Sep 2021 Revised: 18 Oct 2021 Accepted: 4 Nov 2021 Published: 18 Nov 2021

Academic Editors: James Fung, Nan Li Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Cholangiocarcinoma (CCA) is a rare but lethal tumor that arises from the intrahepatic, perihilar, or extrahepatic
bile ducts. Complete surgical resection remains the only chance at long-term survival. Unfortunately, most cases of
CCA are clinically silent until late in the disease process, and, combined with the lack of effective screening tests,
many CCAs present as unresectable tumors. CCA workup typically includes a multiphasic chest, abdominal, and
pelvic imaging, liver function tests, and tumor markers (CEA, CA 19-9). Tissue diagnosis is encouraged but not
always necessary. In certain situations, esophagogastroduodenoscopy, colonoscopy, and mammography are
recommended. If resectable, intrahepatic CCAs and perihilar CCAs require a hepatectomy ranging from a wedge
resection to an extended hepatectomy with reconstruction depending on the location and tumor size. In certain
specialized centers, portal vein and hepatic artery reconstruction can be performed with good outcomes and
acceptable morbidity. For resectable extrahepatic CCAs, a pancreaticoduodenectomy is recommended.
Traditionally, few effective adjuvant options have existed for patients after surgery. However, recent randomized
controlled trials support the use of either adjuvant chemotherapy or chemoradiation therapy after surgical
resection. In select patients, intra-arterial therapy options such as transarterial chemoembolization, hepatic artery
infusion therapy, or yttrium-90 radioembolization, as well as liver transplant, are effective treatment modalities.
Improved surgical techniques, regionalization of care to high-volume centers, and appropriate application of
preoperative optimization techniques have safely expanded the candidates of potentially resectable patients and
improved patient outcomes.

Keywords: Cholangiocarcinoma, hepatectomy, pancreaticoduodenectomy, bile duct, intrahepatic, extrahepatic,
perihilar

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.hrjournal.net