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Review
. 2024 May 21;16(11):1946.
doi: 10.3390/cancers16111946.

Cholangiocarcinoma: The Current Status of Surgical Options including Liver Transplantation

Abdullah Esmail  1 , Mohamed Badheeb  2 , Batool Alnahar  3 , Bushray Almiqlash  4 , Yara Sakr  5 , Bayan Khasawneh  1 , Ebtesam Al-Najjar  1 , Hadeel Al-Rawi  6 , Ala Abudayyeh  7 , Yaser Rayyan  8 , Maen Abdelrahim  1
Affiliations
Review

Cholangiocarcinoma: The Current Status of Surgical Options including Liver Transplantation

Abdullah Esmail et al. Cancers (Basel). .

Abstract

Cholangiocarcinoma (CCA) poses a substantial threat as it ranks as the second most prevalent primary liver tumor. The documented annual rise in intrahepatic CCA (iCCA) incidence in the United States is concerning, indicating its growing impact. Moreover, the five-year survival rate after tumor resection is only 25%, given that tumor recurrence is the leading cause of death in 53-79% of patients. Pre-operative assessments for iCCA focus on pinpointing tumor location, biliary tract involvement, vascular encasements, and metastasis detection. Numerous studies have revealed that portal vein embolization (PVE) is linked to enhanced survival rates, improved liver synthetic functions, and decreased overall mortality. The challenge in achieving clear resection margins contributes to the notable recurrence rate of iCCA, affecting approximately two-thirds of cases within one year, and results in a median survival of less than 12 months for recurrent cases. Nearly 50% of patients initially considered eligible for surgical resection in iCCA cases are ultimately deemed ineligible during surgical exploration. Therefore, staging laparoscopy has been proposed to reduce unnecessary laparotomy. Eligibility for orthotopic liver transplantation (OLT) requires certain criteria to be granted. OLT offers survival advantages for early-detected unresectable iCCA; it can be combined with other treatments, such as radiofrequency ablation and transarterial chemoembolization, in specific cases. We aim to comprehensively describe the surgical strategies available for treating CCA, including the preoperative measures and interventions, alongside the current options regarding liver resection and OLT.

Keywords: OLT; cholangiocarcinoma; extrahepatic cholangiocarcinoma (eCCA); intrahepatic cholangiocarcinoma (iCCA); liver resection and PVE; liver transplantation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 5
Figure 5
Outcomes of intrahepatic and peri-hilar cholangiocarcinoma by treatment modalities [16,21,66,82,152,154,155,160,161,162,167,168,169,170,171,172,173].
Figure 1
Figure 1
Age-standardized mortality rate/100,000 population for cholangiocarcinoma (CCA). Intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma (eCCA) [3].
Figure 2
Figure 2
Prevalence of genetic variants in cholangiocarcinoma (CCA).
Figure 3
Figure 3
Preoperative portal vein embolization (PVE).
Figure 4
Figure 4
Patterns of liver lymphatic drainage. Right hemi-liver tumors drain to lymph nodes in the hepatoduodenal ligament and subsequently to peri-pancreatic and aortocaval lymph nodes. In contrast, left hemi-liver tumors drain towards lymph nodes near the left and common hepatic artery before progressing to the celiac axis.
See this image and copyright information in PMC

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