Materiały źródłowe

• #1 Hilar cholangiocarcinoma: diagnosis, treatment options, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3955000/

  Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. A large number of HC patients are jaundiced and hepatic resection in this setting has been associated with increased postoperative complications. Therefore, biliary drainage of the FLR should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. Local excision of only the extrahepatic biliary tree should be avoided, as this approach is associated with a high likelihood of an R1 (microscopic) or R2 (macroscopic) resection, as well as worse lymph node clearance and worse survival. In general, 5-year survival after surgical resection of HC ranges from 10% to 40%. Of note, even following an R0 resection, recurrence can be as high as 50-70%.

• #2 Hilar cholangiocarcinoma: diagnosis, treatment options, and management – Soares – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/3374/html

  Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. A large number of HC patients are jaundiced and hepatic resection in this setting has been associated with increased postoperative complications. Therefore, biliary drainage of the FLR should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. Local excision of only the extrahepatic biliary tree should be avoided, as this approach is associated with a high likelihood of an R1 (microscopic) or R2 (macroscopic) resection, as well as worse lymph node clearance and worse survival. In general, 5-year survival after surgical resection of HC ranges from 10% to 40%. Of note, even following an R0 resection, recurrence can be as high as 50-70%. The role of minimally invasive HC resections also remains unclear. Some authors have recommended operative palliation in patients who undergo a laparotomy and are then found to have unresectable disease. Surgical palliation in HC consists of cholecystectomy and a biliary-enteric anastomosis for biliary drainage. Although surgical biliary drainage is associated with improved patency rates, there is increased morbidity and mortality along with no difference in overall survival when surgical palliation is compared to non-operative management. Over the last decade, orthotopic liver transplantation (OLT) has shown promise in the treatment of unresectable HC. The treatment protocol consists of external beam radiation, transcatheter radiation with radiosensitizing 5-FU followed by oral capecitabine until the day of transplantation. In conclusion, HC is a rare but aggressive disease with a dismal long-term prognosis. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. R0 resection represents the only chance for long-term survival.

• #3

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  Hilar cholangiocarcinoma (h-CCA) originates from the epithelial cells, which characters as longitudinal growth along the bile ducts and invasion of peripheral vascular nerves. […] For patients who are not amenable to resection, systemic therapy and palliative treatment become the way to go. […] Given the poor prognosis of h-CCA, radical resection (R0) undoubtfully becomes the only irreplaceable treatment to prolonged survival. […] Thus, tumors free boundary assessment along the bile duct hit the crucial point. […] In this review, we summarize the clinical palliative care for advanced h-CCA patients and new opportunities for medications, discussing liver transplantation and other available treatment that not widely disseminated. […] Preoperative assessment of the tumor extent is essential for estimating surgical feasibility and determining the most appropriate resection line.

• #4 Hilar cholangiocarcinoma: diagnosis, treatment options, and management – Soares – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/3374/html

  Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. A large number of HC patients are jaundiced and hepatic resection in this setting has been associated with increased postoperative complications. Therefore, biliary drainage of the FLR should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. Local excision of only the extrahepatic biliary tree should be avoided, as this approach is associated with a high likelihood of an R1 (microscopic) or R2 (macroscopic) resection, as well as worse lymph node clearance and worse survival. In general, 5-year survival after surgical resection of HC ranges from 10% to 40%. Of note, even following an R0 resection, recurrence can be as high as 50-70%. The role of minimally invasive HC resections also remains unclear. Some authors have recommended operative palliation in patients who undergo a laparotomy and are then found to have unresectable disease. Surgical palliation in HC consists of cholecystectomy and a biliary-enteric anastomosis for biliary drainage. Although surgical biliary drainage is associated with improved patency rates, there is increased morbidity and mortality along with no difference in overall survival when surgical palliation is compared to non-operative management. Over the last decade, orthotopic liver transplantation (OLT) has shown promise in the treatment of unresectable HC. The treatment protocol consists of external beam radiation, transcatheter radiation with radiosensitizing 5-FU followed by oral capecitabine until the day of transplantation. In conclusion, HC is a rare but aggressive disease with a dismal long-term prognosis. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. R0 resection represents the only chance for long-term survival.

• #5 National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

  https://www.wjgnet.com/1007-9327/full/v30/i9/1018.htm

  A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute Research Centre (PKLI RC) after initial consultations with the experts. […] The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. […] The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. […] Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. […] The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. […] Selected patients with unresectable hCCA can be considered for liver transplantation.

• #6 Cholangiocarcinoma: Treatment, Outcomes, and Nutrition Overview for Oncology Nurses | Oncology Nursing Society

  https://www.ons.org/publications-research/cjon/22/4/cholangiocarcinoma-treatment-outcomes-and-nutrition-overview

  Cholangiocarcinoma is a cancer that arises from the bile ducts inside or outside of the liver. […] The lethality of this cancer stems, in part, from challenges with supportive care during treatment. […] Nursing literature regarding cholangiocarcinoma is scarce. Studies that focus on nursing care, symptom management, and nursing management of patients with biliary obstruction are needed. Nutrition and palliative care management of patients with cholangiocarcinoma are key areas of nursing management.

• #7 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Recommendation 1: All patients with CCA discussed at multidisciplinary team (MDT) meetings should be classified as best as possible into either intrahepatic, perihilar or distal CCA. This should be clearly recorded in the MDT outcome discussion. […] […] Recommendation 4: All centres managing patients with CCA should have clear established diagnostic pathways for patients presenting with jaundice/biliary obstruction, with streamlined transition to local and regional HPB MDT meetings. […] […] Recommendation 5: Having completed imaging, all patients should undergo a detailed review of clinical presentation, examination findings, blood investigations and imaging, ideally at a regionally coordinated hepatobiliary MDT meeting, with prompt assessment of the results and communication with the patient. […]

• #8 Biliary Cancer – Phoebe Putney Health System

  https://phoebehealth.com/cancer/cancers-we-treat/biliary-cancer/

  Hilar cholangiocarcinoma is found at the bile duct confluence, where the liver and gallbladder connect. […] Phoebe Cancer Center’s expert care team of skilled surgeons, radiologists, and nurses will help guide you through the treatment and post-treatment healing process. […] Our full team approach to cancer care, means providing a highly collaborative effort to deliver comprehensive cancer care to our cancer patients.

• #9 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  As such, molecular profiling should be performed in patients with advanced HC and patients should be referred to clinical trials as appropriate. […] Patients with resectable HC and no metastatic disease should undergo upfront surgery, and surgery remains the cornerstone of treatment. […] The decision for surgery should be made in collaboration with a multidisciplinary tumor board in the context of other treatment modalities. […] Given the anatomic location of HC, patients often require a bile duct resection, partial hepatectomy, and biliary enteric reconstruction. […] The extent of resection is based on the BismuthCorlette classification system. […] Unfortunately, given the aggressive nature of HC, 50-70% of patients will develop recurrence after surgery. […] Achieving an R0 resection can prevent early local recurrence and improve survival.

• #10 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Recommendation 47: All patients diagnosed with CCA should have access to a hepatobiliary cancer nurse specialist who can provide expertise and support to the patient and their immediate family. […] […] Recommendation 48: All patients diagnosed with CCA should have access to a dietician. […] […] Recommendation 49: All patients diagnosed with CCA should have timely access to high-quality information and should be directed to a dedicated CCA patient charity so that they can access support and information. […] […] Recommendation 50: All patients with CCA should be facilitated to access a second specialist clinical opinion if they need to seek reassurance about either their diagnosis or treatment.

• #11 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Recommendation 47: All patients diagnosed with CCA should have access to a hepatobiliary cancer nurse specialist who can provide expertise and support to the patient and their immediate family. […] […] Recommendation 48: All patients diagnosed with CCA should have access to a dietician. […] […] Recommendation 49: All patients diagnosed with CCA should have timely access to high-quality information and should be directed to a dedicated CCA patient charity so that they can access support and information. […] […] Recommendation 50: All patients with CCA should be facilitated to access a second specialist clinical opinion if they need to seek reassurance about either their diagnosis or treatment.

• #12

  https://link.springer.com/article/10.1007/s10353-018-0529-x

  Surgical resection remains the only proven curative treatment for peri-hilar cholangiocarcinoma. Despite recent advances in liver surgery techniques and perioperative care, resection for peri-hilar cholangiocarcinoma remains associated with significant morbidity and mortality. […] Optimal perioperative management has the potential to deliver improved outcomes. This article seeks to summarize the evidence underpinning best practice in the perioperative care of patients undergoing resection of peri-hilar cholangiocarcinoma. […] Research to improve postoperative outcomes through optimized perioperative management is urgently needed to reduce this mortality and morbidity burden and minimize management variation. […] Nutritional deficiencies in patients presenting with pCCA pose a significant risk to perioperative outcomes.

• #13

  https://link.springer.com/article/10.1007/s10353-018-0529-x

  The impact of biliary stenting on preoperative nutritional optimization has not been documented in cholangiocarcinoma. […] In view of the complications associated with peri-hilar resection, we routinely follow-up all postoperative patients within 2 weeks of resection. In addition, all patients have access to a hepatobiliary specialist nurse-led telephone clinic. […] There remains room for significant improvement in the perioperative management of pCCA. Optimized evidence-based perioperative management strategies represent a target to improve outcome in these patients.

• #14 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Not every patient with unresectable HC needs palliative intervention. Patients with complications of cholangitis and intractable pruritus are definite candidates for palliation. Palliation is also often performed in patients with abdominal pain and high bilirubin with the hope of ameliorating their pain and sense of well-being, respectively. There are three established methods for the palliation of HC: endoscopic insertion of a stent, percutaneous placement of biliary drainage and surgical bypass. Endosonography-guided procedures have been evolving as alternatives to these standard techniques. […] It is important to institute antibiotic prophylaxis in patients with anticipated incomplete biliary drainage by any technique. Antibiotics should be continued in cases of incomplete biliary drainage. The choice of antibiotics should be based on local hospital data.

• #15 Hilar cholangiocarcinoma: diagnosis, treatment options, and management – Soares – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/3374/html

  Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. A large number of HC patients are jaundiced and hepatic resection in this setting has been associated with increased postoperative complications. Therefore, biliary drainage of the FLR should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. Local excision of only the extrahepatic biliary tree should be avoided, as this approach is associated with a high likelihood of an R1 (microscopic) or R2 (macroscopic) resection, as well as worse lymph node clearance and worse survival. In general, 5-year survival after surgical resection of HC ranges from 10% to 40%. Of note, even following an R0 resection, recurrence can be as high as 50-70%. The role of minimally invasive HC resections also remains unclear. Some authors have recommended operative palliation in patients who undergo a laparotomy and are then found to have unresectable disease. Surgical palliation in HC consists of cholecystectomy and a biliary-enteric anastomosis for biliary drainage. Although surgical biliary drainage is associated with improved patency rates, there is increased morbidity and mortality along with no difference in overall survival when surgical palliation is compared to non-operative management. Over the last decade, orthotopic liver transplantation (OLT) has shown promise in the treatment of unresectable HC. The treatment protocol consists of external beam radiation, transcatheter radiation with radiosensitizing 5-FU followed by oral capecitabine until the day of transplantation. In conclusion, HC is a rare but aggressive disease with a dismal long-term prognosis. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. R0 resection represents the only chance for long-term survival.

• #16 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The use of prehabilitation and rehabilitation exercise programs is recommended to optimize patient performance status. […] Patients with ECOG (Eastern Cooperative Oncology Group) score 3 are unlikely to benefit from treatment and should be managed with best supportive care. […] The European Network for the Study of Cholangiocarcinoma (ENS-CC), the NCCN, and the ESMO guidelines recommend neoadjuvant chemoradiotherapy and liver transplant evaluation for patients with unresectable HC or HC in the setting of PSC. […] Neoadjuvant therapy can improve the rate of margin-negative resection, downstage patients initially thought to be unresectable, treat micrometastatic disease, and improve patient selection for major surgery. […] The use of radiation therapy in the palliative setting has been well-supported in patients who are not candidates for resection or who have undergone palliative bypass.

• #17 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The use of prehabilitation and rehabilitation exercise programs is recommended to optimize patient performance status. […] Patients with ECOG (Eastern Cooperative Oncology Group) score 3 are unlikely to benefit from treatment and should be managed with best supportive care. […] The European Network for the Study of Cholangiocarcinoma (ENS-CC), the NCCN, and the ESMO guidelines recommend neoadjuvant chemoradiotherapy and liver transplant evaluation for patients with unresectable HC or HC in the setting of PSC. […] Neoadjuvant therapy can improve the rate of margin-negative resection, downstage patients initially thought to be unresectable, treat micrometastatic disease, and improve patient selection for major surgery. […] The use of radiation therapy in the palliative setting has been well-supported in patients who are not candidates for resection or who have undergone palliative bypass.

• #18 Hilar cholangiocarcinoma: diagnosis, treatment options, and management – Soares – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/3374/html

  Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. A large number of HC patients are jaundiced and hepatic resection in this setting has been associated with increased postoperative complications. Therefore, biliary drainage of the FLR should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. Local excision of only the extrahepatic biliary tree should be avoided, as this approach is associated with a high likelihood of an R1 (microscopic) or R2 (macroscopic) resection, as well as worse lymph node clearance and worse survival. In general, 5-year survival after surgical resection of HC ranges from 10% to 40%. Of note, even following an R0 resection, recurrence can be as high as 50-70%. The role of minimally invasive HC resections also remains unclear. Some authors have recommended operative palliation in patients who undergo a laparotomy and are then found to have unresectable disease. Surgical palliation in HC consists of cholecystectomy and a biliary-enteric anastomosis for biliary drainage. Although surgical biliary drainage is associated with improved patency rates, there is increased morbidity and mortality along with no difference in overall survival when surgical palliation is compared to non-operative management. Over the last decade, orthotopic liver transplantation (OLT) has shown promise in the treatment of unresectable HC. The treatment protocol consists of external beam radiation, transcatheter radiation with radiosensitizing 5-FU followed by oral capecitabine until the day of transplantation. In conclusion, HC is a rare but aggressive disease with a dismal long-term prognosis. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. R0 resection represents the only chance for long-term survival.

• #19

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  With the aim of achieving negative margins on all cuts and complete eradication of the tumor with invaded tissues, hepatectomy combined with portal vein resection (PVR) or hepatic artery resection (HAR) then reconstruction is demanding. […] Intraoperative ultrasound can be used to observe the morphology of intra and extrahepatic biliary system and its relationship with the surrounding tissues from a close distance by taking advantage of high-frequency probe and direct-contact scanning. […] Postoperative mortality in h-CCA patients is caused mostly by post-hepatectomy liver failure (PHLF). […] Liver transplantation (LT) following neoadjuvant chemoradiotherapy offers a new option for those patients who have lost the chance of radical resection or underlying chronic liver disease precluding resection.

• #20 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Not every patient with unresectable HC needs palliative intervention. Patients with complications of cholangitis and intractable pruritus are definite candidates for palliation. Palliation is also often performed in patients with abdominal pain and high bilirubin with the hope of ameliorating their pain and sense of well-being, respectively. There are three established methods for the palliation of HC: endoscopic insertion of a stent, percutaneous placement of biliary drainage and surgical bypass. Endosonography-guided procedures have been evolving as alternatives to these standard techniques. […] It is important to institute antibiotic prophylaxis in patients with anticipated incomplete biliary drainage by any technique. Antibiotics should be continued in cases of incomplete biliary drainage. The choice of antibiotics should be based on local hospital data.

• #21

  https://link.springer.com/article/10.1007/s10353-018-0529-x

  The impact of biliary stenting on preoperative nutritional optimization has not been documented in cholangiocarcinoma. […] In view of the complications associated with peri-hilar resection, we routinely follow-up all postoperative patients within 2 weeks of resection. In addition, all patients have access to a hepatobiliary specialist nurse-led telephone clinic. […] There remains room for significant improvement in the perioperative management of pCCA. Optimized evidence-based perioperative management strategies represent a target to improve outcome in these patients.

• #22

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  Hilar cholangiocarcinoma (h-CCA) originates from the epithelial cells, which characters as longitudinal growth along the bile ducts and invasion of peripheral vascular nerves. […] For patients who are not amenable to resection, systemic therapy and palliative treatment become the way to go. […] Given the poor prognosis of h-CCA, radical resection (R0) undoubtfully becomes the only irreplaceable treatment to prolonged survival. […] Thus, tumors free boundary assessment along the bile duct hit the crucial point. […] In this review, we summarize the clinical palliative care for advanced h-CCA patients and new opportunities for medications, discussing liver transplantation and other available treatment that not widely disseminated. […] Preoperative assessment of the tumor extent is essential for estimating surgical feasibility and determining the most appropriate resection line.

• #23 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Not every patient with unresectable HC needs palliative intervention. Patients with complications of cholangitis and intractable pruritus are definite candidates for palliation. Palliation is also often performed in patients with abdominal pain and high bilirubin with the hope of ameliorating their pain and sense of well-being, respectively. There are three established methods for the palliation of HC: endoscopic insertion of a stent, percutaneous placement of biliary drainage and surgical bypass. Endosonography-guided procedures have been evolving as alternatives to these standard techniques. […] It is important to institute antibiotic prophylaxis in patients with anticipated incomplete biliary drainage by any technique. Antibiotics should be continued in cases of incomplete biliary drainage. The choice of antibiotics should be based on local hospital data.

• #24 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise.

• #25 Hilar cholangiocarcinoma (bile duct cancer): stage, treatment, surgery | Dr. Nikhil Agrawal

  https://www.drnikhilagrawal.com/bile-duct-cancer-cholangiocarcinoma-hilar

  In cases where patients present with unresectable or metastatic disease, the primary objective of treatment is to provide palliative care, focusing on symptom management and improving the quality of life. Jaundice can be relieved through procedures such as percutaneous transhepatic biliary drainage (PTBD) and metallic stenting. Once jaundice is under control, chemotherapy or chemoradiotherapy is given. The aim is to extend survival and improve the overall quality of life for these patients.

• #26 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Due to its invasiveness, surgical bypass has a very limited role to play in palliating hilar tumors. It is only accepted when all of the other techniques described above have failed or are not available, as well as occasionally when laparotomy has been performed for curative intent but an unresectable tumor is revealed. The various surgical drainage procedures that can be carried out include segment III hepaticojejunostomy, stent placement across the tumor and sectoral duct (i.e., right anterior, right posterior or left hepatic duct) bypass. However, segment III bypass is the preferred choice because it resolves jaundice in approximately two-thirds of HC patients and has a median survival of approximately 6.3 mo.

• #27 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise.

• #28 Palliation: Hilar cholangiocarcinoma

  https://www.wjgnet.com/1948-5182/full/v6/i8/559.htm

  Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise.

• #29 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The recommendations of various society guidelines are summarized in Table 3. […] Capecitabine has been generally accepted as the standard-of-care adjuvant therapy for patients with a resected BTC. […] The immune system plays a critical role in cancer treatment. […] The recent Topaz I phase III trial evaluated the combination of immunotherapy and chemotherapy in patients with advanced BTCs. […] Research is currently ongoing and focused on other combinations of immunotherapy and chemotherapy. […] Hilar cholangiocarcinoma is a subtype of CCA that arises from the common hepatic duct and extends proximally into the hepatic duct confluence, the right hepatic duct, and/or the left hepatic duct. […] When feasible, HC should be managed with upfront surgery followed by adjuvant capecitabine. […] Continued translational research with collaboration between the lab and clinical teams will be critical to moving the field forward.

• #30 National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

  https://www.wjgnet.com/1007-9327/full/v30/i9/1018.htm

  Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. […] The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. […] Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. […] Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA. […] Surgical resection remains the best curative treatment option. […] For unresectable cases, liver transplantation is considered under strict selection criteria. […] Preoperative biliary drainage and portal vein embolisation decisions may be needed for selective cases. […] The role of Immunotherapy is emerging and offers improved survival for irresectable hilar cholangiocarcinoma.

• #31 Chemotherapy for Bile Duct Cancer (Cholangiocarcinoma) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bile-duct-cancer-cholangiocarcinoma/treatment/chemotherapy

  If you have bile duct cancer that has spread, you may receive chemotherapy as the main treatment if surgery is not an option. Research has suggested that the combination of gemcitabine and cisplatin can lengthen the lives of people with bile duct cancer that cannot be removed by surgery. […] Chemotherapy is also occasionally given to relieve symptoms due to bile duct cancer, such as a tumor that is pressing on a nerve and causing pain. […] HAI therapy may be used to shrink tumors before surgery.

• #32 Chemotherapy for Bile Duct Cancer (Cholangiocarcinoma) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bile-duct-cancer-cholangiocarcinoma/treatment/chemotherapy

  Medical oncologist Ghassan Abou-Alfa and his clinical team work closely to ensure that chemotherapy and other treatments are well-coordinated. This provides patients with the highest level of care. […] Chemotherapy is a drug or a combination of drugs that kills cancer cells wherever they are in the body. You may receive chemotherapy before surgery to shrink a bile duct tumor. This is called neoadjuvant therapy. If you receive chemotherapy after surgery to destroy and cancer cells that may remain, it is called adjuvant therapy. […] The standard chemotherapy drugs for bile duct cancer are gemcitabine (Gemzar) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU), oxaliplatin (Eloxatin), and capecitabine (Xeloda). We will carefully tailor your treatment to make sure that its as effective as possible while helping maintain your quality of life.

• #33 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The recommendations of various society guidelines are summarized in Table 3. […] Capecitabine has been generally accepted as the standard-of-care adjuvant therapy for patients with a resected BTC. […] The immune system plays a critical role in cancer treatment. […] The recent Topaz I phase III trial evaluated the combination of immunotherapy and chemotherapy in patients with advanced BTCs. […] Research is currently ongoing and focused on other combinations of immunotherapy and chemotherapy. […] Hilar cholangiocarcinoma is a subtype of CCA that arises from the common hepatic duct and extends proximally into the hepatic duct confluence, the right hepatic duct, and/or the left hepatic duct. […] When feasible, HC should be managed with upfront surgery followed by adjuvant capecitabine. […] Continued translational research with collaboration between the lab and clinical teams will be critical to moving the field forward.

• #34 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  Upfront surgery with adjuvant capecitabine is the only curative treatment for hilar cholangiocarcinoma. […] Unfortunately, most patients do not present with resectable disease and are treated with a combination of locoregional therapy and systemic therapy. […] For patients with resectable disease, the standard of care is upfront surgery with adjuvant capecitabine. […] While surgery confers the greatest survival advantage, most patients will develop recurrent or metastatic disease afterwards. […] Systemic therapy options for these patients are limited and do little to improve long-term survival. […] Given the tumor heterogeneity associated with CCA, research has focused on developing effective targeted therapies. […] Targeted therapy carries a better side effect profile than cytotoxic chemotherapy and can be personalized based on the tumors genomic landscape.

• #35 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The use of prehabilitation and rehabilitation exercise programs is recommended to optimize patient performance status. […] Patients with ECOG (Eastern Cooperative Oncology Group) score 3 are unlikely to benefit from treatment and should be managed with best supportive care. […] The European Network for the Study of Cholangiocarcinoma (ENS-CC), the NCCN, and the ESMO guidelines recommend neoadjuvant chemoradiotherapy and liver transplant evaluation for patients with unresectable HC or HC in the setting of PSC. […] Neoadjuvant therapy can improve the rate of margin-negative resection, downstage patients initially thought to be unresectable, treat micrometastatic disease, and improve patient selection for major surgery. […] The use of radiation therapy in the palliative setting has been well-supported in patients who are not candidates for resection or who have undergone palliative bypass.

• #36

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  For patients present with metastatic or unresectable h-CCA at diagnosis, which approximately consist of 60-70%, systemic therapies or palliative locoregional strategies when necessary are their main treatment options. […] Improvements in external irradiation therapy have facilitated the treatment of h-CCA for palliation. […] In patients with advanced-stage h-CCA, systemic chemotherapeutics of gemcitabine and cisplatin are the primary treatment options. […] PDT may be used as a palliative treatment to reduce symptoms, improve quality of life, or prolong survival. […] NIR-PIT combines the advantages of PDT and immunotherapy. […] Liquid biopsy provides an approximation of the intra-tumor heterogeneity. […] The lack of biological markers to predict the efficacy of targeted therapies attenuates the clinical feasibility of these therapeutic regimens for h-CCA. […] In conclusion, comprehensively judging the findings of all available modalities is important in achieving accurate preoperative assessments.

• #37 Hilar cholangiocarcinoma | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hilar-cholangiocarcinoma?content_id=CON-20202299

  Hilar cholangiocarcinoma is a type of cancer that starts as a growth of cells in the bile ducts. Bile ducts are slender tubes that carry the digestive fluid bile from the liver to the small intestine. […] Treatment for hilar cholangiocarcinoma may include surgery to remove the cancer or a liver transplant. Other treatments may include chemotherapy, radiation therapy, immunotherapy and targeted therapy. […] The goal of surgery for hilar cholangiocarcinoma is to remove all of the cancer. Surgery may not be an option for everyone. This cancer grows near many important structures, which can make surgery difficult. When surgery is possible, options may include: […] Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team’s goal is to improve quality of life for you and your family. […] The use of palliative care with other treatments can help people with cancer feel better and live longer.

• #38 Hilar cholangiocarcinoma | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20202299/

  Hilar cholangiocarcinoma is a type of cancer that starts as a growth of cells in the bile ducts. […] Treatment for hilar cholangiocarcinoma may include surgery to remove the cancer or a liver transplant. Other treatments may include chemotherapy, radiation therapy, immunotherapy and targeted therapy. […] The goal of surgery for hilar cholangiocarcinoma is to remove all of the cancer. Surgery may not be an option for everyone. […] Your healthcare team considers many factors when creating a treatment plan. These factors may include your overall health, the type and stage of your cancer, and your preferences. […] Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. […] The use of palliative care with other treatments can help people with cancer feel better and live longer.

• #39 Hilar cholangiocarcinoma | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hilar-cholangiocarcinoma?content_id=CON-20202299

  Hilar cholangiocarcinoma is a type of cancer that starts as a growth of cells in the bile ducts. Bile ducts are slender tubes that carry the digestive fluid bile from the liver to the small intestine. […] Treatment for hilar cholangiocarcinoma may include surgery to remove the cancer or a liver transplant. Other treatments may include chemotherapy, radiation therapy, immunotherapy and targeted therapy. […] The goal of surgery for hilar cholangiocarcinoma is to remove all of the cancer. Surgery may not be an option for everyone. This cancer grows near many important structures, which can make surgery difficult. When surgery is possible, options may include: […] Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team’s goal is to improve quality of life for you and your family. […] The use of palliative care with other treatments can help people with cancer feel better and live longer.

• #40 Cholangiocarcinoma Follow-up: Further Outpatient Care, Complications, Prognosis

  https://emedicine.medscape.com/article/277393-followup

  Most patients with cholangiocarcinoma require follow-up care for acute and late adverse effects of therapy. Aggressive follow-up care also is necessary to treat symptoms from tumor recurrence and persistence. Patients with the best prognosis may be seen every 2-3 months with periodic laboratory and imaging studies (eg, CT scan). […] Patients treated palliatively should enter hospice programs rapidly, as median survival duration is only 2-8 months.

• #41 Cholangiocarcinoma: Treatment, Outcomes, and Nutrition Overview for Oncology Nurses | Oncology Nursing Society

  https://www.ons.org/publications-research/cjon/22/4/cholangiocarcinoma-treatment-outcomes-and-nutrition-overview

  Cholangiocarcinoma is a cancer that arises from the bile ducts inside or outside of the liver. […] The lethality of this cancer stems, in part, from challenges with supportive care during treatment. […] Nursing literature regarding cholangiocarcinoma is scarce. Studies that focus on nursing care, symptom management, and nursing management of patients with biliary obstruction are needed. Nutrition and palliative care management of patients with cholangiocarcinoma are key areas of nursing management.

• #42 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Recommendation 47: All patients diagnosed with CCA should have access to a hepatobiliary cancer nurse specialist who can provide expertise and support to the patient and their immediate family. […] […] Recommendation 48: All patients diagnosed with CCA should have access to a dietician. […] […] Recommendation 49: All patients diagnosed with CCA should have timely access to high-quality information and should be directed to a dedicated CCA patient charity so that they can access support and information. […] […] Recommendation 50: All patients with CCA should be facilitated to access a second specialist clinical opinion if they need to seek reassurance about either their diagnosis or treatment.

• #43 Cholangiocarcinoma (bile duct cancer) – Liver Foundation

  https://liver.org.au/your-liver/liver-diseases/cholangiocarcinoma-bile-duct-cancer/

  Cholangiocarcinoma is a rare cancer that grows in the bile ducts. […] Hilar cholangiocarcinoma is when the cancer grows in the bile ducts just outside of the liver. […] If you have cholangiocarcinoma, you will be referred to a specialist such as a liver surgeon, gastroenterologist or medical oncologist. […] Possible treatments depend on your unique tumour and how widespread it is. […] Good nutrition will help you keep a healthy weight, maintain your muscle strength and give you energy. […] Here are some nutrition tips for people with cholangiocarcinoma: Talk to your doctor or an accredited practising dietitian about a suitable diet that packs as much nutrition as possible into everything you eat. […] Avoid all alcohol to protect your liver. […] Tell your doctor if symptoms are bothering you, as there are many ways to relieve them.

• #44 Cholangiocarcinoma (bile duct cancer) – Liver Foundation

  https://liver.org.au/your-liver/liver-diseases/cholangiocarcinoma-bile-duct-cancer/

  Cholangiocarcinoma is a rare cancer that grows in the bile ducts. […] Hilar cholangiocarcinoma is when the cancer grows in the bile ducts just outside of the liver. […] If you have cholangiocarcinoma, you will be referred to a specialist such as a liver surgeon, gastroenterologist or medical oncologist. […] Possible treatments depend on your unique tumour and how widespread it is. […] Good nutrition will help you keep a healthy weight, maintain your muscle strength and give you energy. […] Here are some nutrition tips for people with cholangiocarcinoma: Talk to your doctor or an accredited practising dietitian about a suitable diet that packs as much nutrition as possible into everything you eat. […] Avoid all alcohol to protect your liver. […] Tell your doctor if symptoms are bothering you, as there are many ways to relieve them.

• #45 Cholangiocarcinoma Follow-up: Further Outpatient Care, Complications, Prognosis

  https://emedicine.medscape.com/article/277393-followup

  Most patients with cholangiocarcinoma require follow-up care for acute and late adverse effects of therapy. Aggressive follow-up care also is necessary to treat symptoms from tumor recurrence and persistence. Patients with the best prognosis may be seen every 2-3 months with periodic laboratory and imaging studies (eg, CT scan). […] Patients treated palliatively should enter hospice programs rapidly, as median survival duration is only 2-8 months.

• #46 Cholangiocarcinoma Follow-up: Further Outpatient Care, Complications, Prognosis

  https://emedicine.medscape.com/article/277393-followup

  Most patients with cholangiocarcinoma require follow-up care for acute and late adverse effects of therapy. Aggressive follow-up care also is necessary to treat symptoms from tumor recurrence and persistence. Patients with the best prognosis may be seen every 2-3 months with periodic laboratory and imaging studies (eg, CT scan). […] Patients treated palliatively should enter hospice programs rapidly, as median survival duration is only 2-8 months.

• #47

  https://link.springer.com/article/10.1007/s10353-018-0529-x

  The impact of biliary stenting on preoperative nutritional optimization has not been documented in cholangiocarcinoma. […] In view of the complications associated with peri-hilar resection, we routinely follow-up all postoperative patients within 2 weeks of resection. In addition, all patients have access to a hepatobiliary specialist nurse-led telephone clinic. […] There remains room for significant improvement in the perioperative management of pCCA. Optimized evidence-based perioperative management strategies represent a target to improve outcome in these patients.

• #48 Robotic Surgery Offers Potential New Strategy for Hilar Cholangiocarcinoma Resection

  https://www.ajmc.com/view/robotic-surgery-offers-potential-new-strategy-for-hilar-cholangiocarcinoma-resection

  Robotic surgery may be the best option for patients in need of highly complex surgical resection operations for hilar cholangiocarcinoma (HC), but a new systematic review says the currently available evidence is inconclusive. […] The only treatment for HC that is considered curative is surgical resection. Given the nature of the cancer, however, such surgeries are highly complex and difficult, Brolese and colleagues said. […] Oncological biliary tract resection is one of the most challenging abdominal procedures, with high rates of major morbidity and recurrence, the authors wrote. […] The optimal surgical treatment for an oncological resection of HC is radical extrahepatic bile duct resection in conjunction with major hepatectomy, radical lymphadenectomy, and Roux-en-Y hepaticojejunostomy reconstruction.

• #49 Robotic Surgery Offers Potential New Strategy for Hilar Cholangiocarcinoma Resection

  https://www.ajmc.com/view/robotic-surgery-offers-potential-new-strategy-for-hilar-cholangiocarcinoma-resection

  Robotic surgery may be the best option for patients in need of highly complex surgical resection operations for hilar cholangiocarcinoma (HC), but a new systematic review says the currently available evidence is inconclusive. […] The only treatment for HC that is considered curative is surgical resection. Given the nature of the cancer, however, such surgeries are highly complex and difficult, Brolese and colleagues said. […] Oncological biliary tract resection is one of the most challenging abdominal procedures, with high rates of major morbidity and recurrence, the authors wrote. […] The optimal surgical treatment for an oncological resection of HC is radical extrahepatic bile duct resection in conjunction with major hepatectomy, radical lymphadenectomy, and Roux-en-Y hepaticojejunostomy reconstruction.

• #50 Robotic Surgery Offers Potential New Strategy for Hilar Cholangiocarcinoma Resection

  https://www.ajmc.com/view/robotic-surgery-offers-potential-new-strategy-for-hilar-cholangiocarcinoma-resection

  The authors said patients lost an average of 662 milliliters of blood in the case reports and series for which data were available. Overall, one-third of patients needed blood transfusions. […] Pooled postoperative morbidity and mortality was 39.8% and 1.8% respectively, the investigators reported. […] Brolese and colleagues said their review demonstrates that robotic surgery is safe, but they said the data was insufficient to draw conclusions about the overall benefits of robotic surgery versus non-robotic operations. […] The authors said there are a number of factors that must be considered when determining whether to use robotic surgery on patients with HC, including patient characteristics and organizational factors. However, they said additional research is warranted in order to paint a clearer picture of the benefits and potential drawbacks of robotic surgery in these cases. […] The main criticism in the majority of series is the very long operative time. However, if surgery must become increasingly precise today, robotic surgery for the treatment of HC may become one of the best indications and potentially the most suitable tool for quality surgery, they wrote.

• #51

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  Hilar cholangiocarcinoma (h-CCA) originates from the epithelial cells, which characters as longitudinal growth along the bile ducts and invasion of peripheral vascular nerves. […] For patients who are not amenable to resection, systemic therapy and palliative treatment become the way to go. […] Given the poor prognosis of h-CCA, radical resection (R0) undoubtfully becomes the only irreplaceable treatment to prolonged survival. […] Thus, tumors free boundary assessment along the bile duct hit the crucial point. […] In this review, we summarize the clinical palliative care for advanced h-CCA patients and new opportunities for medications, discussing liver transplantation and other available treatment that not widely disseminated. […] Preoperative assessment of the tumor extent is essential for estimating surgical feasibility and determining the most appropriate resection line.

• #52

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  To address these issues, image-guided surgery has been introduced, and recent reports suggest it enhanced intraoperative tumor margins localization and precise tumor-free boundary positioning. […] Near-infrared region (NIR-II) light performed in treatment combined with immune target molecules considered as kind of palliative therapy for advanced patients. […] IDUS can be used preoperatively to help surgeon determine the tumor extension so as to formulate the surgical plan and the extent of liver resection, but there have been no case reports of its real-time intraoperative guidance. […] The author has used IDUS undergo operation for the first time ever, the outcomes turn out well. […] As surgery is the only curative therapy, preoperative evaluation of the tumor axial and lateral infiltration is essential.

• #53

  https://journals.lww.com/international-journal-of-surgery/fulltext/2025/02000/current_advance_in_comprehensive_management_of.41.aspx

  With the aim of achieving negative margins on all cuts and complete eradication of the tumor with invaded tissues, hepatectomy combined with portal vein resection (PVR) or hepatic artery resection (HAR) then reconstruction is demanding. […] Intraoperative ultrasound can be used to observe the morphology of intra and extrahepatic biliary system and its relationship with the surrounding tissues from a close distance by taking advantage of high-frequency probe and direct-contact scanning. […] Postoperative mortality in h-CCA patients is caused mostly by post-hepatectomy liver failure (PHLF). […] Liver transplantation (LT) following neoadjuvant chemoradiotherapy offers a new option for those patients who have lost the chance of radical resection or underlying chronic liver disease precluding resection.

• #54 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  Upfront surgery with adjuvant capecitabine is the only curative treatment for hilar cholangiocarcinoma. […] Unfortunately, most patients do not present with resectable disease and are treated with a combination of locoregional therapy and systemic therapy. […] For patients with resectable disease, the standard of care is upfront surgery with adjuvant capecitabine. […] While surgery confers the greatest survival advantage, most patients will develop recurrent or metastatic disease afterwards. […] Systemic therapy options for these patients are limited and do little to improve long-term survival. […] Given the tumor heterogeneity associated with CCA, research has focused on developing effective targeted therapies. […] Targeted therapy carries a better side effect profile than cytotoxic chemotherapy and can be personalized based on the tumors genomic landscape.

• #55 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The recommendations of various society guidelines are summarized in Table 3. […] Capecitabine has been generally accepted as the standard-of-care adjuvant therapy for patients with a resected BTC. […] The immune system plays a critical role in cancer treatment. […] The recent Topaz I phase III trial evaluated the combination of immunotherapy and chemotherapy in patients with advanced BTCs. […] Research is currently ongoing and focused on other combinations of immunotherapy and chemotherapy. […] Hilar cholangiocarcinoma is a subtype of CCA that arises from the common hepatic duct and extends proximally into the hepatic duct confluence, the right hepatic duct, and/or the left hepatic duct. […] When feasible, HC should be managed with upfront surgery followed by adjuvant capecitabine. […] Continued translational research with collaboration between the lab and clinical teams will be critical to moving the field forward.

• #56 Multi-Disciplinary Care of Hilar Cholangiocarcinoma: Review of Guidelines and Recent Advancements

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10778096/

  The recommendations of various society guidelines are summarized in Table 3. […] Capecitabine has been generally accepted as the standard-of-care adjuvant therapy for patients with a resected BTC. […] The immune system plays a critical role in cancer treatment. […] The recent Topaz I phase III trial evaluated the combination of immunotherapy and chemotherapy in patients with advanced BTCs. […] Research is currently ongoing and focused on other combinations of immunotherapy and chemotherapy. […] Hilar cholangiocarcinoma is a subtype of CCA that arises from the common hepatic duct and extends proximally into the hepatic duct confluence, the right hepatic duct, and/or the left hepatic duct. […] When feasible, HC should be managed with upfront surgery followed by adjuvant capecitabine. […] Continued translational research with collaboration between the lab and clinical teams will be critical to moving the field forward.

• #57 Hilar cholangiocarcinoma | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hilar-cholangiocarcinoma?content_id=CON-20202299

  Hilar cholangiocarcinoma is a type of cancer that starts as a growth of cells in the bile ducts. Bile ducts are slender tubes that carry the digestive fluid bile from the liver to the small intestine. […] Treatment for hilar cholangiocarcinoma may include surgery to remove the cancer or a liver transplant. Other treatments may include chemotherapy, radiation therapy, immunotherapy and targeted therapy. […] The goal of surgery for hilar cholangiocarcinoma is to remove all of the cancer. Surgery may not be an option for everyone. This cancer grows near many important structures, which can make surgery difficult. When surgery is possible, options may include: […] Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team’s goal is to improve quality of life for you and your family. […] The use of palliative care with other treatments can help people with cancer feel better and live longer.

• #58

  https://link.springer.com/article/10.1007/s10353-018-0529-x

  The impact of biliary stenting on preoperative nutritional optimization has not been documented in cholangiocarcinoma. […] In view of the complications associated with peri-hilar resection, we routinely follow-up all postoperative patients within 2 weeks of resection. In addition, all patients have access to a hepatobiliary specialist nurse-led telephone clinic. […] There remains room for significant improvement in the perioperative management of pCCA. Optimized evidence-based perioperative management strategies represent a target to improve outcome in these patients.

• #59 Treatment for bile duct cancer – NHS

  https://www.nhs.uk/conditions/bile-duct-cancer/treatment/

  The specialist care team looking after you will: […] help you manage any side effects, including changes to your diet to help with your digestion. […] If the cancer has spread too far and cannot be removed, you may have surgery to help control some symptoms of bile duct cancer. […] The aim of these operations is to help improve your symptoms and help you live longer, not to cure the cancer. […] You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team. […] They will work with you to help manage your symptoms and make you feel more comfortable. […] The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.

• #60 Klatskin Tumors (Hilar Cholangiocarcinoma)

  https://my.clevelandclinic.org/health/diseases/hilar-cholangiocarcinoma

  Hilar cholangiocarcinoma is a form of extrahepatic bile duct cancer. […] Healthcare providers may be able to cure this condition if they detect and treat tumors before they spread. Surgery, including liver transplant, is the most common treatment. Providers have other treatments that ease symptoms. […] Managing symptoms may be challenging, so don’t hesitate to ask your healthcare provider for help. […] Treatments will vary depending on your situation, but surgery is a common front-line or initial treatment for this condition. Surgery may be: […] Providers may use chemoradiation, which combines chemotherapy and radiation therapy, along with surgery or when surgery isn’t an option. […] Ask your provider what changes to expect, like symptoms that get worse or new symptoms. Don’t hesitate to contact them for help managing symptoms like pain or nausea and vomiting. Your provider will have treatments to reduce symptoms that affect your daily and your quality of life. […] If you have this condition, your healthcare team will help you manage symptoms and treatment side effects. They’ll also be glad to suggest clinical trials you may want to consider.

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