Management of hilar cholangiocarcinoma

Abstract

INTRODUCTION AND OBJECTIVES: Cholangiocarcinoma (CCA) is a malignant disease involving the biliary system with majority occurring in the hilar region. Cholangiocarcinoma demands prompt management because of its aggressive nature. METHODS: Patients who presented to North Colombo Teaching Hospital- Liver Unit (NCTH- LU) and National Hospital of Sri Lanka (NHSL- GHU) from January 2011 to March 2014 were included in this study. Diagnosis was made by CT imaging, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Total of 108 patients were diagnosed with CCA. The median age of presentation was 62 years (range 31-87). 51.4% were males. Majority (58.3%) of CCA occurred in the hilar region with rest involving the common bile duct. 76.8 % were stented and 8 patients were offered surgical treatment. Out of 62 hilar CCA 46 were classified according to the bismuth classification. 9 were type I, 8 were type II, 13 were type III and 16 were type IV. Six patients underwent hepatic resection, Majority (n=46) were stented, six were treated with radiofrequency ablation. Out of 45 patients with CBD involvement 33 were stented and 2 had Whipple's surgery. Six patients who underwent surgery are currently followed up at NCTH-LU. CONCLUSIONS: Surgery appears to be the effective treatment for cholangiocarcinoma. Aggressive palliation with stenting was beneficial.