Treatment of Cholangiocarcinoma with Resectable (Operable) Disease on Imaging and Staging

Clinical Scenario

This protocol applies to patients with cholangiocarcinoma in whom imaging and formal staging confirm resectable, operable disease. In this selected population, surgical resection is the only therapeutic option — other than liver transplantation in a small proportion of carefully selected patients — that offers a potential cure.

Treatment Approach

The management strategy centres on a curative surgical resection performed at a high-volume hepatobiliary centre. Preoperative preparation to optimise liver function before surgery may be required, and the complete protocol describes the specific preparatory steps and operative considerations involved.

Treatment Goal

The primary objective is achievement of a complete (R0) resection with negative resection margins — the essential requirement for curative intent.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/gutjnl-2023-330029

R0 resection is the only curative treatment available.
Surgical resection is the only therapeutic option (other than liver transplantation for a small proportion of selected patients) that offers a potential cure for CCA.
Preoperative preparation, including augmentation of the functional liver remnant (FLR) and biliary drainage, may be required to ensure safe resection.
The main approaches to augmentation are portal vein embolisation (PVE); portal vein ligation (PVL); and associated liver partition and portal vein ligation (ALPPS).
A complete (R0) resection with an adequate liver remnant is the preferred surgical treatment.

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