Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions

Siddharth Mehrotra, Shailendra Lalwani, Samiran Nundy Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, IndiaCorrespondence: Samiran Nundy Email snundy@hotmail.comAbstract: Advances in imaging, pathology and therapy have resulted in major improveme...

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Autores principales:	Mehrotra S, Lalwani S, Nundy S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	cholangiocarcinoma – preoperative preparation - surgery Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/0993c7df7c6f47de833804f7f53f0371
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spelling	oai:doaj.org-article:0993c7df7c6f47de833804f7f53f03712021-12-02T09:46:18ZManagement Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions1179-1535https://doaj.org/article/0993c7df7c6f47de833804f7f53f03712020-01-01T00:00:00Zhttps://www.dovepress.com/management-strategies-for-patients-with-hilar-cholangiocarcinomas-chal-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Siddharth Mehrotra, Shailendra Lalwani, Samiran Nundy Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, IndiaCorrespondence: Samiran Nundy Email snundy@hotmail.comAbstract: Advances in imaging, pathology and therapy have resulted in major improvements in the management of cholangiocarcinomas; the mortality has come down and with it there has been an improved 5-year survival. Surgical resection remains the treatment of choice and reports from high volume centres have shown an increase in resectability rates, R0 resection, a decrease in mortality and an improvement in 5-year survival; however, the operative morbidity remains high, pointing towards the complexity of the management of these difficult lesions. Complete excision is also often limited by the locally advanced nature of the disease at the time of diagnosis and a proportion of patients who were earlier deemed resectable on imaging are found to have unresectable disease at the time of operation. Neoadjuvant therapy has had only a limited impact on survival. Liver transplantation is also an option in a few patients following strict criteria for selection. Since the large majority of patients are only diagnosed at the late stages of the disease palliation (endoscopic or surgical) is an important part of treatment. Portal vein embolisation and pre-operative biliary drainage have had a major impact on outcomes. Major liver resection with caudate lobe removal remains the standard operation and procedures like routine vascular resection and liver transplant should only be carried out in experienced centres. Improvements in both neo as well as adjuvant therapy may lead to a standardized protocol in the future, as well as an improvement in survival.Keywords: cholangiocarcinoma, preoperative preparation, surgeryMehrotra SLalwani SNundy SDove Medical Pressarticlecholangiocarcinoma – preoperative preparation - surgeryDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 12, Pp 1-13 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	cholangiocarcinoma – preoperative preparation - surgery Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	cholangiocarcinoma – preoperative preparation - surgery Diseases of the digestive system. Gastroenterology RC799-869 Mehrotra S Lalwani S Nundy S Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
description	Siddharth Mehrotra, Shailendra Lalwani, Samiran Nundy Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, IndiaCorrespondence: Samiran Nundy Email snundy@hotmail.comAbstract: Advances in imaging, pathology and therapy have resulted in major improvements in the management of cholangiocarcinomas; the mortality has come down and with it there has been an improved 5-year survival. Surgical resection remains the treatment of choice and reports from high volume centres have shown an increase in resectability rates, R0 resection, a decrease in mortality and an improvement in 5-year survival; however, the operative morbidity remains high, pointing towards the complexity of the management of these difficult lesions. Complete excision is also often limited by the locally advanced nature of the disease at the time of diagnosis and a proportion of patients who were earlier deemed resectable on imaging are found to have unresectable disease at the time of operation. Neoadjuvant therapy has had only a limited impact on survival. Liver transplantation is also an option in a few patients following strict criteria for selection. Since the large majority of patients are only diagnosed at the late stages of the disease palliation (endoscopic or surgical) is an important part of treatment. Portal vein embolisation and pre-operative biliary drainage have had a major impact on outcomes. Major liver resection with caudate lobe removal remains the standard operation and procedures like routine vascular resection and liver transplant should only be carried out in experienced centres. Improvements in both neo as well as adjuvant therapy may lead to a standardized protocol in the future, as well as an improvement in survival.Keywords: cholangiocarcinoma, preoperative preparation, surgery
format	article
author	Mehrotra S Lalwani S Nundy S
author_facet	Mehrotra S Lalwani S Nundy S
author_sort	Mehrotra S
title	Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
title_short	Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
title_full	Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
title_fullStr	Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
title_full_unstemmed	Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions
title_sort	management strategies for patients with hilar cholangiocarcinomas: challenges and solutions
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/0993c7df7c6f47de833804f7f53f0371
work_keys_str_mv	AT mehrotras managementstrategiesforpatientswithhilarcholangiocarcinomaschallengesandsolutions AT lalwanis managementstrategiesforpatientswithhilarcholangiocarcinomaschallengesandsolutions AT nundys managementstrategiesforpatientswithhilarcholangiocarcinomaschallengesandsolutions
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Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions

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