Approach to Resectable Biliary Cancers

Kimberly Washington, Flavio Rocha

    Research output: Contribution to journalReview articlepeer-review

    Abstract

    Biliary malignancies, although rare, can be some of the most challenging to manage surgically. Intrahepatic cholangiocarcinomas are resectable if there is no evidence of metastatic disease. These tumors are managed with anatomic resection and portal lymphadenectomy when centrally located or multiple in a single lobe. Non-anatomic resection can be performed for solitary peripheral tumors with minimally invasive techniques. It is not our practice to routinely employ neoadjuvant chemotherapy prior to resection of these tumors. Hepatic arterial infusion chemotherapy is utilized at our institution in highly selected patients in the context of an ongoing clinical trial for unresectable tumors. Hilar cholangiocarcinomas, when resectable (i.e., ipsilateral arterial involvement or lack of vascular involvement), are managed with right or left (extended) hepatectomy, caudate resection, and portal lymphadenectomy. Distal cholangiocarcinomas are managed with pancreaticoduodenectomy. Neoadjuvant chemotherapy is not routinely used in our treatment algorithm of extrahepatic cholangiocarcinomas. Nodal involvement and positive margin (R1) resection necessitates adjuvant chemotherapy. Finally, gallbladder carcinoma is managed with radical cholecystectomy, anatomic segment IVb/V resection, and portal lymphadenectomy. Adjuvant chemotherapy is employed routinely amongst patients with T2 or higher tumors and those with positive lymph nodes.

    Original languageEnglish (US)
    Article number97
    JournalCurrent treatment options in oncology
    Volume22
    Issue number11
    DOIs
    StatePublished - Nov 2021

    Keywords

    • Cholangiocarcinoma
    • Extrahepatic cholangiocarcinoma
    • Gallbladder cancer
    • Hilar cholangiocarcinoma
    • Intrahepatic cholangiocarcinoma

    ASJC Scopus subject areas

    • Oncology
    • Pharmacology (medical)

    Fingerprint

    Dive into the research topics of 'Approach to Resectable Biliary Cancers'. Together they form a unique fingerprint.

    Cite this