Treatment of Cholangiocarcinoma with Resectable (Operable) Disease on Imaging and Staging
When cholangiocarcinoma is assessed as resectable on imaging and staging workup, the clinical pathway centres on achieving the most complete surgical resection possible, followed by careful consideration of post-surgical management.
Clinical Scenario
Cholangiocarcinoma confirmed as resectable (operable) disease on imaging and staging. Surgical resection is the only therapeutic option — alongside liver transplantation for a small proportion of carefully selected patients — that offers a potential cure. Achieving an R0 (microscopically clear margin) resection is the primary surgical goal.
Treatment Approach (Partial Overview)
For patients with extrahepatic cholangiocarcinoma in whom surgical resection results in a microscopically positive margin (R1 resection), adjuvant chemoradiotherapy may be considered as part of post-surgical management.
Full regimen details, sequencing, and eligibility criteria are available in the structured protocol.
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 (see section on liver transplantation, and possibly ablation for small iCCA) that offers a potential cure for CCA.
- Consider the use of adjuvant chemoradiotherapy for extrahepatic CCA or gallbladder cancer and a microscopically positive surgical margin resection (R1 resection) with a shared decision-making approach, considering the risk of potential harm and potential for benefit.
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