Skip to main content

Perioperative Management of Hilar Cholangiocarcinoma

Journal of Gastrointestinal Surgery volume 19, pages 1889–1899 (2015)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Bragazzi MC CV, Carpino G, Venere R, Semeraro R, Gentile R, Gaudio E, Alvaro D. Cholangiocarcinoma: Epidemiology and risk factors. Transl Gastrointest Cancer 2012; 1:21–32.

  2. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States Part III: Liver, biliary tract, and pancreas. Gastroenterology 2009; 136(4):1134–44.

    PubMed  Article  Google Scholar 

  3. Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 1998; 228(3):385–94.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  4. Launois B, Reding R, Lebeau G, et al. Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg 2000; 7(2):128–34.

    CAS  PubMed  Article  Google Scholar 

  5. Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996; 224(4):463–73; discussion 473-5.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  6. Welzel TM, McGlynn KA, Hsing AW, et al. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J Natl Cancer Inst 2006; 98(12):873–5.

    PubMed  Article  Google Scholar 

  7. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 2007; 245(5):755–62.

    PubMed Central  PubMed  Article  Google Scholar 

  8. Klatskin G. Adenocarcinoma of the Hepatic Duct at Its Bifurcation within the Porta Hepatis. An Unusual Tumor with Distinctive Clinical and Pathological Features. Am J Med 1965; 38:241–56.

    CAS  PubMed  Article  Google Scholar 

  9. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001; 234(4):507–17; discussion 517-9.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  10. Cho MS, Kim SH, Park SW, et al. Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience. J Gastrointest Surg 2012; 16(9):1672–9.

    PubMed  Article  Google Scholar 

  11. Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol 2013; 5(7):132–8.

    PubMed Central  PubMed  Article  Google Scholar 

  12. Khan SA, Toledano MB, Taylor-Robinson SD. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB (Oxford) 2008; 10(2):77–82.

    CAS  Article  Google Scholar 

  13. Shin HR, Oh JK, Masuyer E, et al. Epidemiology of cholangiocarcinoma: an update focusing on risk factors. Cancer Sci 2010; 101(3):579–85.

    CAS  PubMed  Article  Google Scholar 

  14. Choi D, Lim JH, Lee KT, et al. Cholangiocarcinoma and Clonorchis sinensis infection: a case–control study in Korea. J Hepatol 2006; 44(6):1066–73.

    PubMed  Article  Google Scholar 

  15. Lee TY, Lee SS, Jung SW, et al. Hepatitis B virus infection and intrahepatic cholangiocarcinoma in Korea: a case–control study. Am J Gastroenterol 2008; 103(7):1716–20.

    PubMed  Article  Google Scholar 

  16. Honjo S, Srivatanakul P, Sriplung H, et al. Genetic and environmental determinants of risk for cholangiocarcinoma via Opisthorchis viverrini in a densely infested area in Nakhon Phanom, northeast Thailand. Int J Cancer 2005; 117(5):854–60.

    CAS  PubMed  Article  Google Scholar 

  17. El-Serag HB, Engels EA, Landgren O, et al. Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection: a population-based study of U.S. veterans. Hepatology 2009; 49(1):116–23.

    PubMed Central  PubMed  Article  Google Scholar 

  18. Shaib YH, El-Serag HB, Nooka AK, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a hospital-based case–control study. Am J Gastroenterol 2007; 102(5):1016–21.

    PubMed  Article  Google Scholar 

  19. Ben-Menachem T. Risk factors for cholangiocarcinoma. Eur J Gastroenterol Hepatol 2007; 19(8):615–7.

    PubMed  Article  Google Scholar 

  20. Broome U, Olsson R, Loof L, et al. Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut 1996; 38(4):610–5.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  21. Tischendorf JJ, Hecker H, Kruger M, et al. Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: a single center study. Am J Gastroenterol 2007; 102(1):107–14.

    PubMed  Article  Google Scholar 

  22. Burak K, Angulo P, Pasha TM, et al. Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol 2004; 99(3):523–6.

    PubMed  Article  Google Scholar 

  23. Rosen CB, Nagorney DM, Wiesner RH, et al. Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg 1991; 213(1):21–5.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  24. Boberg KM, Bergquist A, Mitchell S, et al. Cholangiocarcinoma in primary sclerosing cholangitis: risk factors and clinical presentation. Scand J Gastroenterol 2002; 37(10):1205–11.

    CAS  PubMed  Article  Google Scholar 

  25. Goss JA, Shackleton CR, Farmer DG, et al. Orthotopic liver transplantation for primary sclerosing cholangitis. A 12-year single center experience. Ann Surg 1997; 225(5):472–81; discussion 481-3.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  26. Chazouilleres O. Primary sclerosing cholangitis and biliary malignancy: a glimmer of hope? J Hepatol 2004; 40(5):857–9.

    PubMed  Article  Google Scholar 

  27. Kuang D, Wang GP. Hilar cholangiocarcinoma: pathology and tumor biology. Front Med China 2010; 4(4):371–7.

    PubMed  Article  Google Scholar 

  28. Altaee MY, Johnson PJ, Farrant JM, et al. Etiologic and clinical characteristics of peripheral and hilar cholangiocarcinoma. Cancer 1991; 68(9):2051–5.

    CAS  PubMed  Article  Google Scholar 

  29. Maroni L, Pierantonelli I, Banales JM, et al. The significance of genetics for cholangiocarcinoma development. Ann Transl Med 2013; 1(3):28.

    PubMed Central  PubMed  Google Scholar 

  30. Batheja N, Suriawinata A, Saxena R, et al. Expression of p53 and PCNA in cholangiocarcinoma and primary sclerosing cholangitis. Mod Pathol 2000; 13(12):1265–8.

    CAS  PubMed  Article  Google Scholar 

  31. Tullo A, D’Erchia AM, Honda K, et al. New p53 mutations in hilar cholangiocarcinoma. Eur J Clin Invest 2000; 30(9):798–803.

    CAS  PubMed  Article  Google Scholar 

  32. Tannapfel A, Sommerer F, Benicke M, et al. Mutations of the BRAF gene in cholangiocarcinoma but not in hepatocellular carcinoma. Gut 2003; 52(5):706–12.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  33. Tada M, Omata M, Ohto M. High incidence of ras gene mutation in intrahepatic cholangiocarcinoma. Cancer 1992; 69(5):1115–8.

    CAS  PubMed  Article  Google Scholar 

  34. Ohashi K, Tstsumi M, Nakajima Y, et al. Ki-ras point mutations and proliferation activity in biliary tract carcinomas. Br J Cancer 1996; 74(6):930–5.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  35. Isa T, Tomita S, Nakachi A, et al. Analysis of microsatellite instability, K-ras gene mutation and p53 protein overexpression in intrahepatic cholangiocarcinoma. Hepatogastroenterology 2002; 49(45):604–8.

    CAS  PubMed  Google Scholar 

  36. Blechacz B, Gores GJ. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment. Hepatology 2008; 48(1):308–21.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  37. Weinbren K, Mutum SS. Pathological aspects of cholangiocarcinoma. J Pathol 1983; 139(2):217–38.

    CAS  PubMed  Article  Google Scholar 

  38. Jarnagin W, Winston C. Hilar cholangiocarcinoma: diagnosis and staging. HPB (Oxford) 2005; 7(4):244–51.

    Article  Google Scholar 

  39. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 1975; 140(2):170–8.

    CAS  PubMed  Google Scholar 

  40. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 1992; 215(1):31–8.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  41. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17(6):1471–4.

    PubMed  Article  Google Scholar 

  42. Zervos EE, Osborne D, Goldin SB, et al. Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach. Am J Surg 2005; 190(5):810–5.

    PubMed  Article  Google Scholar 

  43. de Jong MC, Hong SM, Augustine MM, et al. Hilar cholangiocarcinoma: tumor depth as a predictor of outcome. Arch Surg 2011; 146(6):697–703.

    PubMed Central  PubMed  Article  Google Scholar 

  44. Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg 2012; 215(3):343–55.

    PubMed  Article  Google Scholar 

  45. Anderson CD, Pinson CW, Berlin J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist 2004; 9(1):43–57.

    PubMed  Article  Google Scholar 

  46. Benson AB, 3rd, Abrams TA, Ben-Josef E, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009; 7(4):350–91.

    PubMed Central  CAS  PubMed  Google Scholar 

  47. Patel AH, Harnois DM, Klee GG, et al. The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol 2000; 95(1):204–7.

    CAS  PubMed  Article  Google Scholar 

  48. Van Beers BE. Diagnosis of cholangiocarcinoma. HPB (Oxford) 2008; 10(2):87–93.

    Article  Google Scholar 

  49. Nehls O, Gregor M, Klump B. Serum and bile markers for cholangiocarcinoma. Semin Liver Dis 2004; 24(2):139–54.

    CAS  PubMed  Article  Google Scholar 

  50. Juntermanns B, Radunz S, Heuer M, et al. Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res 2010; 15(8):357–61.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  51. Cha JH, Han JK, Kim TK, et al. Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability. Abdom Imaging 2000; 25(5):500–7.

    CAS  PubMed  Article  Google Scholar 

  52. Choi ER, Chung YH, Lee JK, et al. Preoperative evaluation of the longitudinal extent of borderline resectable hilar cholangiocarcinoma by intraductal ultrasonography. J Gastroenterol Hepatol 2011; 26(12):1804–10.

    PubMed  Article  Google Scholar 

  53. Aloia TA, Charnsangavej C, Faria S, et al. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 2007; 193(6):702–6.

    PubMed  Article  Google Scholar 

  54. Watadani T, Akahane M, Yoshikawa T, et al. Preoperative assessment of hilar cholangiocarcinoma using multidetector-row CT: correlation with histopathological findings. Radiat Med 2008; 26(7):402–7.

    PubMed  Article  Google Scholar 

  55. Chen HW, Lai EC, Pan AZ, et al. Preoperative assessment and staging of hilar cholangiocarcinoma with 16-multidetector computed tomography cholangiography and angiography. Hepatogastroenterology 2009; 56(91–92):578–83.

    CAS  PubMed  Google Scholar 

  56. Akamatsu N, Sugawara Y, Osada H, et al. Diagnostic accuracy of multidetector-row computed tomography for hilar cholangiocarcinoma. J Gastroenterol Hepatol 2010; 25(4):731–7.

    PubMed  Article  Google Scholar 

  57. Choi JY, Kim MJ, Lee JM, et al. Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 2008; 191(5):1448–57.

    PubMed  Article  Google Scholar 

  58. Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging 2008; 33(4):444–51.

    PubMed  Article  Google Scholar 

  59. Sai JK, Suyama M, Kubokawa Y, et al. Early detection of extrahepatic bile-duct carcinomas in the nonicteric stage by using MRCP followed by EUS. Gastrointest Endosc 2009; 70(1):29–36.

    PubMed  Article  Google Scholar 

  60. Holzknecht N, Gauger J, Sackmann M, et al. Breath-hold MR cholangiography with snapshot techniques: prospective comparison with endoscopic retrograde cholangiography. Radiology 1998; 206(3):657–64.

    CAS  PubMed  Article  Google Scholar 

  61. Yeh TS, Jan YY, Tseng JH, et al. Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings. Am J Gastroenterol 2000; 95(2):432–40.

    CAS  PubMed  Article  Google Scholar 

  62. Fulcher AS, Turner MA. HASTE MR cholangiography in the evaluation of hilar cholangiocarcinoma. AJR Am J Roentgenol 1997; 169(6):1501–5.

    CAS  PubMed  Article  Google Scholar 

  63. Silva MA, Tekin K, Aytekin F, et al. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol 2005; 31(5):533–9.

    CAS  PubMed  Article  Google Scholar 

  64. Park MS, Kim TK, Kim KW, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 2004; 233(1):234–40.

    PubMed  Article  Google Scholar 

  65. Byrne MF, Gerke H, Mitchell RM, et al. Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy 2004; 36(8):715–9.

    CAS  PubMed  Article  Google Scholar 

  66. Lee JH, Salem R, Aslanian H, et al. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures. Am J Gastroenterol 2004; 99(6):1069–73.

    PubMed  Article  Google Scholar 

  67. Eloubeidi MA, Chen VK, Jhala NC, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol 2004; 2(3):209–13.

    PubMed  Article  Google Scholar 

  68. Rauws EA, Kloek JJ, Gouma DJ, et al. Staging of cholangiocarcinoma: the role of endoscopy. HPB (Oxford) 2008; 10(2):110–2.

    CAS  Article  Google Scholar 

  69. Heimbach JK, Sanchez W, Rosen CB, et al. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford) 2011; 13(5):356–60.

    Article  Google Scholar 

  70. Cherqui D, Benoist S, Malassagne B, et al. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 2000; 135(3):302–8.

    CAS  PubMed  Article  Google Scholar 

  71. Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191(1):38–46.

    CAS  PubMed  Article  Google Scholar 

  72. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28(4):593–607.

    PubMed  Article  Google Scholar 

  73. Liu F, Li Y, Wei Y, et al. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig Dis Sci 2011; 56(3):663–72.

    PubMed  Article  Google Scholar 

  74. Tsai HM, Chuang CH, Lin XZ, et al. Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma. World J Gastroenterol 2009; 15(41):5206–10.

    PubMed Central  PubMed  Article  Google Scholar 

  75. Grandadam S, Compagnon P, Arnaud A, et al. Role of preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma type III. Ann Surg Oncol 2010; 17(12):3155–61.

    PubMed  Article  Google Scholar 

  76. Farges O, Belghiti J, Kianmanesh R, et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003; 237(2):208–17.

    PubMed Central  PubMed  Google Scholar 

  77. Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002; 137(6):675–80; discussion 680-1.

    PubMed  Article  Google Scholar 

  78. Hemming AW, Reed AI, Howard RJ, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003; 237(5):686–91; discussion 691-3.

    PubMed Central  PubMed  Google Scholar 

  79. van Lienden KP, van den Esschert JW, de Graaf W, et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 2013; 36(1):25–34.

    PubMed Central  PubMed  Article  Google Scholar 

  80. Weiss MJ, Cosgrove D, Herman JM, et al. Multimodal treatment strategies for advanced hilar cholangiocarcinoma. Langenbecks Arch Surg 2014; 399(6):679–92.

    PubMed  Article  Google Scholar 

  81. Parikh AA, Abdalla EK, Vauthey JN. Operative considerations in resection of hilar cholangiocarcinoma. HPB (Oxford) 2005; 7(4):254–8.

    Article  Google Scholar 

  82. Connor S, Barron E, Wigmore SJ, et al. The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J Gastrointest Surg 2005; 9(4):476–80.

    PubMed  Article  Google Scholar 

  83. Weber SM, DeMatteo RP, Fong Y, et al. Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg 2002; 235(3):392–9.

    PubMed Central  PubMed  Article  Google Scholar 

  84. Barlow AD, Garcea G, Berry DP, et al. Staging laparoscopy for hilar cholangiocarcinoma in 100 patients. Langenbecks Arch Surg 2013; 398(7):983–8.

    PubMed  Article  Google Scholar 

  85. Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 2010; 17(4):476–89.

    PubMed  Article  Google Scholar 

  86. Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg 2012; 147(1):26–34.

    PubMed  Article  Google Scholar 

  87. Shimizu H, Kimura F, Yoshidome H, et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg 2010; 251(2):281–6.

    PubMed  Article  Google Scholar 

  88. Unno M, Katayose Y, Rikiyama T, et al. Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 2010; 17(4):463–9.

    PubMed  Article  Google Scholar 

  89. Regimbeau JM, Fuks D, Pessaux P, et al. Tumour size over 3 cm predicts poor short-term outcomes after major liver resection for hilar cholangiocarcinoma. By the HC-AFC-2009 group. HPB (Oxford) 2015; 17(1):79–86.

    Article  Google Scholar 

  90. Zheng-Rong L, Hai-Bo Y, Xin C, et al. Resection and drainage of hilar cholangiocarcinoma: an 11-year experience of a single center in mainland China. Am Surg 2011; 77(5):627–33.

    PubMed  Google Scholar 

  91. Shi Z, Yang MZ, He QL, et al. Addition of hepatectomy decreases liver recurrence and leads to long survival in hilar cholangiocarcinoma. World J Gastroenterol 2009; 15(15):1892–6.

    PubMed Central  PubMed  Article  Google Scholar 

  92. Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence. Ann Surg 2008; 248(2):273–9.

    PubMed  Article  Google Scholar 

  93. Dinant S, Gerhards MF, Busch OR, et al. The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma. HPB (Oxford) 2005; 7(4):263–7.

    Article  Google Scholar 

  94. Kow AW, Wook CD, Song SC, et al. Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a 15-year experience in a tertiary institution. World J Surg 2012; 36(5):1112–21.

    PubMed  Article  Google Scholar 

  95. Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV. Eur J Surg Oncol 2012; 38(12):1197–203.

    PubMed  Article  Google Scholar 

  96. Wu XS, Dong P, Gu J, et al. Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies. J Gastrointest Surg 2013; 17(6):1107–15.

    PubMed  Article  Google Scholar 

  97. de Jong MC, Marques H, Clary BM, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer 2012; 118(19):4737–47.

    PubMed  Article  Google Scholar 

  98. Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. HPB (Oxford) 2013; 15(7):492–503.

    Article  Google Scholar 

  99. Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 2007; 141(5):581–8.

    PubMed  Article  Google Scholar 

  100. Cheng Q, Luo X, Zhang B, et al. Predictive factors for prognosis of hilar cholangiocarcinoma: postresection radiotherapy improves survival. Eur J Surg Oncol 2007; 33(2):202–7.

    CAS  PubMed  Article  Google Scholar 

  101. Song SC, Choi DW, Kow AW, et al. Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre. ANZ J Surg 2013; 83(4):268–74.

    PubMed  Article  Google Scholar 

  102. Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996; 223(4):384–94.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  103. Abdel Wahab M, Fathy O, Elghwalby N, et al. Resectability and prognostic factors after resection of hilar cholangiocarcinoma. Hepatogastroenterology 2006; 53(67):5–10.

    CAS  PubMed  Google Scholar 

  104. Shimoda M, Farmer DG, Colquhoun SD, et al. Liver transplantation for cholangiocellular carcinoma: analysis of a single-center experience and review of the literature. Liver Transpl 2001; 7(12):1023–33.

    CAS  PubMed  Article  Google Scholar 

  105. Meyer CG, Penn I, James L. Liver transplantation for cholangiocarcinoma: results in 207 patients. Transplantation 2000; 69(8):1633–7.

    CAS  PubMed  Article  Google Scholar 

  106. Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int 2010; 23(7):692–7.

    PubMed  Article  Google Scholar 

  107. Heimbach JK, Haddock MG, Alberts SR, et al. Transplantation for hilar cholangiocarcinoma. Liver Transpl 2004; 10(10 Suppl 2):S65–8.

    PubMed  Article  Google Scholar 

  108. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 2005; 242(3):451–8; discussion 458-61.

    PubMed Central  PubMed  Google Scholar 

  109. Rosen CB, Heimbach JK, Gores GJ. Surgery for cholangiocarcinoma: the role of liver transplantation. HPB (Oxford) 2008; 10(3):186–9.

    CAS  Article  Google Scholar 

  110. Nakeeb A, Pitt HA. Radiation therapy, chemotherapy and chemoradiation in hilar cholangiocarcinoma. HPB (Oxford) 2005; 7(4):278–82.

    Article  Google Scholar 

  111. Valle JW, Wasan H, Johnson P, et al. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study—the UK ABC-01 Study. Br J Cancer 2009; 101(4):621–7.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  112. Todoroki T. Chemotherapy for bile duct carcinoma in the light of adjuvant chemotherapy to surgery. Hepatogastroenterology 2000; 47(33):644–9.

    CAS  PubMed  Google Scholar 

  113. Patt YZ, Jones DV, Jr., Hoque A, et al. Phase II trial of intravenous flourouracil and subcutaneous interferon alfa-2b for biliary tract cancer. J Clin Oncol 1996; 14(8):2311–5.

    CAS  PubMed  Google Scholar 

  114. Lee MA, Woo IS, Kang JH, et al. Epirubicin, cisplatin, and protracted infusion of 5-FU (ECF) in advanced intrahepatic cholangiocarcinoma. J Cancer Res Clin Oncol 2004; 130(6):346–50.

    CAS  PubMed  Article  Google Scholar 

  115. Thongprasert S. The role of chemotherapy in cholangiocarcinoma. Ann Oncol 2005; 16 Suppl 2:ii93-6

    PubMed  Google Scholar 

  116. Murakami Y, Uemura K, Sudo T, et al. Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg 2009; 13(8):1470–9.

    PubMed  Article  Google Scholar 

  117. El-Khoueiry AB, Rankin C, Siegel AB, et al. S0941: a phase 2 SWOG study of sorafenib and erlotinib in patients with advanced gallbladder carcinoma or cholangiocarcinoma. Br J Cancer 2014; 110(4):882–7.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  118. El-Khoueiry AB, Rankin CJ, Ben-Josef E, et al. SWOG 0514: a phase II study of sorafenib in patients with unresectable or metastatic gallbladder carcinoma and cholangiocarcinoma. Invest New Drugs 2012; 30(4):1646–51.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  119. Lubner SJ, Mahoney MR, Kolesar JL, et al. Report of a multicenter phase II trial testing a combination of biweekly bevacizumab and daily erlotinib in patients with unresectable biliary cancer: a phase II Consortium study. J Clin Oncol 2010; 28(21):3491–7.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  120. Pitt HA, Nakeeb A, Abrams RA, et al. Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival. Ann Surg 1995; 221(6):788–97; discussion 797-8.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  121. Sagawa N, Kondo S, Morikawa T, et al. Effectiveness of radiation therapy after surgery for hilar cholangiocarcinoma. Surg Today 2005; 35(7):548–52.

    PubMed  Article  Google Scholar 

  122. Gerhards MF, van Gulik TM, Gonzalez Gonzalez D, et al. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg 2003; 27(2):173–9.

    PubMed  Google Scholar 

  123. Todoroki T, Ohara K, Kawamoto T, et al. Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma. Int J Radiat Oncol Biol Phys 2000; 46(3):581–7.

    CAS  PubMed  Article  Google Scholar 

  124. Wang Y, Yang H, Shen C, et al. Surgical procedure and long-term survival of hilar cholangiocarcinoma. Int J Clin Exp Med 2015; 8(1):1122–8.

  125. Higuchi R, Ota T, Yazawa T, et al. Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution. Surg Today 2015. doi:10.1007/s00595-015-1119-1.

  126. Furusawa N, Kobayashi A, Yokoyama T, et al. Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality. World J Surg 2014; 38(5):1164–76.

  127. Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013; 258(1):129–40.

  128. Cannon RM, Brock G, Buell JF. Surgical resection for hilar cholangiocarcinoma: experience improves resectability. HPB (Oxford) 2012; 14(2):142–9.

Download references

Author information

Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Halsted 614 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Katherine E. Poruk, Timothy M. Pawlik & Matthew J. Weiss

Authors
  1. Katherine E. Poruk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew J. Weiss.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Poruk, K.E., Pawlik, T.M. & Weiss, M.J. Perioperative Management of Hilar Cholangiocarcinoma. J Gastrointest Surg 19, 1889–1899 (2015). https://doi.org/10.1007/s11605-015-2854-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-2854-8

Keywords

  • Hilar cholangiocarcinoma
  • Biliary cancer