Onkológia 5/2022

Surgery for biliary tract cancer: current management, challenges and controversies

Cholangiocarcinoma is a malignant epithelial tumour formed in the intrahepatic and extrahepatic (perihilar and distal) biliary tree and classified according to its localization. It is a rare oncological disease, although highly lethal and currently with the rising worldwide incidence. Constant advancements in radiological as well as surgical techniques currently offer different treatment strategies starting from the traditional hepatectomies and proceeding towards complex therapy plan consisting of portal vein embolization, staged hepatectomy and vascular resection. Radical resection is the cornerstone of the multimodal treatment plan for patients with the cholangiocarcinoma, while R0 resection offers the highest chance for overall survival. However, most of the patients are diagnosed at an advanced stage and therefore may be excluded from the surgical therapy. Even though the extent of the resection based on the localization has been defined, surgical technique has improved, while combination of adjuvant systemic therapy is at the disposal, the desired improvements in the long term results have not been achieved. In the constant endeavour towards improved survival of patients with the cholangiocarcinoma the neoadjuvant or perioperative chemo-radiotherapy regimens are examined before surgical resection or liver transplantation. This review summarizes current state and role of surgery in the multimodal therapy plan for patients with cholangiocarcinoma.

Keywords: cholangiocarcinoma, intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, surgical treatment, resectability, resection margin