Treatment of Localised Non-Metastatic Extrahepatic Cholangiocarcinoma Amenable to Complete (R0) Resection

This protocol applies to patients with localised, non-metastatic extrahepatic cholangiocarcinoma (eCCA) in whom staging confirms the tumour is amenable to a margin-negative (R0) surgical resection.

Clinical scenario All patients with non-metastatic extrahepatic cholangiocarcinoma should be evaluated for surgical resection when a complete (R0) resection is considered feasible with acceptable postoperative mortality. This resectable disease setting is the primary context for curative-intent intervention.

Treatment approach — partial overview The recommended strategy centres on a surgical procedure with the specific objective of achieving complete, margin-negative (R0) clearance. In certain cases, additional operative measures targeting vascular structures may be part of the approach to reach this goal. The complete structured protocol — covering patient selection criteria, operative considerations, and further management — is available via the link below.

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References

DOI: 10.1016/j.jhep.2025.03.007

All patients with non-metastatic eCCA should be evaluated for surgical resection if a complete resection (i.e. R0) is feasible with acceptable postoperative mortality.

Patients with localised pCCA should be treated with surgical resection if a complete resection (i.e. R0) is feasible with acceptable postoperative mortality (LoE 2, strong recommendation, strong consensus).

Selected patients with (a suspicion of) pCCA may undergo portal vein or arterial reconstruction if required to achieve R0 resection (LoE 3, weak recommendation, strong consensus).

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