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Review
. 2024 Mar 7;30(9):1018-1042.
doi: 10.3748/wjg.v30.i9.1018.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

Faisal Saud Dar  1 , Zaigham Abbas  2 , Irfan Ahmed  1   3 , Muhammad Atique  4 , Usman Iqbal Aujla  5 , Muhammad Azeemuddin  6 , Zeba Aziz  7 , Abu Bakar Hafeez Bhatti  8 , Tariq Ali Bangash  9 , Amna Subhan Butt  10 , Osama Tariq Butt  5 , Abdul Wahab Dogar  11 , Javed Iqbal Farooqi  12 , Faisal Hanif  13 , Jahanzaib Haider  14 , Siraj Haider  14 , Syed Mujahid Hassan  15 , Adnan Abdul Jabbar  16 , Aman Nawaz Khan  17 , Muhammad Shoaib Khan  18 , Muhammad Yasir Khan  1 , Amer Latif  9 , Nasir Hassan Luck  19 , Ahmad Karim Malik  5 , Kamran Rashid  20 , Sohail Rashid  1 , Mohammad Salih  21 , Abdullah Saeed  22 , Amjad Salamat  23 , Ghias-Un-Nabi Tayyab  24 , Aasim Yusuf  25 , Haseeb Haider Zia  8 , Ammara Naveed  26
Affiliations
Review

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

Faisal Saud Dar et al. World J Gastroenterol. .

Abstract

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 Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. 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. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. 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. 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.

Keywords: Bismuth-Corlette classification; Hepatectomy; Hilar cholangiocarcinoma; Memorial Sloan Kettering Cancer Centre Staging; Portal vein embolisation; Preoperative biliary drainage; Surgical resection.

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Conflict of interest statement

Conflict-of-interest statement: The authors report having no conflicts of interest.

Figures

Figure 1
Figure 1
Anatomical classification of hilar cholangiocarcinoma with International Classification of Diseases-11 codes. CCA: Cholangiocarcinoma.
Figure 2
Figure 2
Bismuth-Corlette classification. Type I: Below the confluence of left and right hepatic ducts; Type II: Reaching confluence but not involving left or right hepatic ducts; Type III: occluding common hepatic duct and involving either the right (IIIa) or left (IIIb) hepatic duct; Type IV: Involving the confluence of both right and left hepatic ducts; bilateral intrahepatic segmental involvement or multicentric.
See this image and copyright information in PMC

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MeSH terms