Hilar Cholangiocarcinoma

Expert consensus statement

John C. Mansour, Thomas A. Aloia, Christopher H. Crane, Julie K. Heimbach, Masato Nagino, Jean Nicolas Vauthey

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of hilar cholangiocarcinoma in order to establish practice guidelines and to agree consensus statements. It was established that the treatment of patients with hilar cholangiocarcinoma requires a coordinated, multidisciplinary approach to optimize the chances for both durable survival and effective palliation. An adequate diagnostic and staging work-up includes high-quality cross-sectional imaging; however, pathologic confirmation is not required prior to resection or initiation of a liver transplant trimodal treatment protocol. The ideal treatment for suitable patients with resectable hilar malignancy is resection of the intra- and extrahepatic bile ducts, as well as resection of the involved ipsilateral liver. Preoperative biliary drainage is best achieved with percutaneous transhepatic approaches and may be indicated for patients with cholangitis, malnutrition or hepatic insufficiency. Portal vein embolization is a safe and effective strategy for increasing the future liver remnant (FLR) and is particularly useful for patients with an FLR of <30%. Selected patients with unresectable hilar cholangiocarcinoma should be evaluated for a standard trimodal protocol incorporating external beam and endoluminal radiation therapy, systemic chemotherapy and liver transplantation. Post-resection chemoradiation should be offered to patients who show high-risk features on surgical pathology. Chemoradiation is also recommended for patients with locally advanced, unresectable hilar cancers. For patients with locally recurrent or metastatic hilar cholangiocarcinoma, first-line chemotherapy with gemcitabine and cisplatin is recommended based on multiple Phase II trials and a large randomized controlled trial including a heterogeneous population of patients with biliary cancers.

Original languageEnglish (US)
Pages (from-to)691-699
Number of pages9
JournalHPB
Volume17
Issue number8
DOIs
StatePublished - Aug 1 2015

Fingerprint

Klatskin Tumor
Liver
gemcitabine
Biliary Tract Neoplasms
Hepatic Insufficiency
Intrahepatic Bile Ducts
Extrahepatic Bile Ducts
Drug Therapy
Surgical Pathology
Cholangitis
Clinical Protocols
Portal Vein
Practice Guidelines
Malnutrition
Liver Transplantation
Cisplatin
Drainage
Neoplasms
Radiotherapy
Randomized Controlled Trials

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Mansour, J. C., Aloia, T. A., Crane, C. H., Heimbach, J. K., Nagino, M., & Vauthey, J. N. (2015). Hilar Cholangiocarcinoma: Expert consensus statement. HPB, 17(8), 691-699. https://doi.org/10.1111/hpb.12450

Hilar Cholangiocarcinoma : Expert consensus statement. / Mansour, John C.; Aloia, Thomas A.; Crane, Christopher H.; Heimbach, Julie K.; Nagino, Masato; Vauthey, Jean Nicolas.

In: HPB, Vol. 17, No. 8, 01.08.2015, p. 691-699.

Research output: Contribution to journalArticle

Mansour, JC, Aloia, TA, Crane, CH, Heimbach, JK, Nagino, M & Vauthey, JN 2015, 'Hilar Cholangiocarcinoma: Expert consensus statement', HPB, vol. 17, no. 8, pp. 691-699. https://doi.org/10.1111/hpb.12450
Mansour JC, Aloia TA, Crane CH, Heimbach JK, Nagino M, Vauthey JN. Hilar Cholangiocarcinoma: Expert consensus statement. HPB. 2015 Aug 1;17(8):691-699. https://doi.org/10.1111/hpb.12450
Mansour, John C. ; Aloia, Thomas A. ; Crane, Christopher H. ; Heimbach, Julie K. ; Nagino, Masato ; Vauthey, Jean Nicolas. / Hilar Cholangiocarcinoma : Expert consensus statement. In: HPB. 2015 ; Vol. 17, No. 8. pp. 691-699.
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