National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.

Ahmad Karim Malik, Faisal Hanif, Jahanzaib Haider, Siraj Haider, Syed Mujahid Hassan, Adnan Abdul Jabbar, Aman Nawaz Khan, Amer Latif, Nasir Hassan Luck, Javed Iqbal Farooqi, Kamran Rashid, Sohail Rashid, Abdullah Saeed, Amjad Salamat, Ghias-Un-Nabi Tayyab, Haseeb Haider Zia, Ammara Naveed, Aasim Yusuf, Abdul Wahab Dogar, Osama Tariq Butt, Amna Subhan Butt, Tariq Ali Bangash, Abu Bakar Hafeez Bhatti, Muhammad Azeemuddin, Usman Iqbal Aujla, Muhammad Atique, Faisal Saud Dar, Irfan Ahmed, Zaigham Abbas, Muhammad Yasir Khan, Mohammad Salih, Zeba Aziz, Muhammad Shoaib Khan

Journal: World journal of gastroenterology 2024;30(9):1018-1042

PMID: 38577184

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Abstract

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Address: Department of Hepatopancreatic Biliary Surgery & Liver Transplant, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan.; Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Karachi 75600, Sindh, Pakistan.; Department of Hepatopancreatic Biliary Surgery & Liver Transplant, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan.; University of Aberdeen, Aberdeen B24 3FX, United Kingdom.; Department of Pathology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan.; Department of Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan.; Department of Radiology, Aga Khan University, Karachi 74800, Pakistan.; Department of Oncology, Hameed Latif Hospital, Lahore 54000, Pakistan.; Division of Hepatopancreatic Biliary Surgery & Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan.; Department of Hepatopancreatic Biliary Surgery & Liver Transplant, Shaikh Zayed Hospital and Post Graduate Medical Institute, Lahore 54000, Pakistan.; Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan.; Department of Liver Transplant, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat 66020, Pakistan.; Department of Medicine & Gastroenterology, Lifecare Hospital and Research Centre, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan.; Department of Hepatopancreatobiliary & Liver Transplant, Bahria International Hospital, Lahore 54000, Pakistan.; Department of Surgery, Hepatopancreatobiliary & Liver Transplant, Dow University of Health Sciences, Karachi 74800, Pakistan.; Department of Gastroenterology, Hepatology & Nutrition, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat 66020, Pakistan.; Department of Oncology, Dr. Ziauddin Hospital, Karachi 74800, Pakistan.; Department of Radiology, Rehman Medical Institute, Peshawar 25000, Pakistan.; Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi 46000, Pakistan.; Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi 75500, Pakistan.; Rashid Nursing Home and Cancer Clinic, Rashid Nursing Home and Cancer Clinic, Rawalpindi 46000, Pakistan.; Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad 44000, Pakistan.; Department of Radiology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan.; Department of Gastroenterology and Hepatology, Quaid-e-Azam International Hospital, Rawalpindi 44000, Pakistan.; Department of Gastroenterology and Hepatology, Post Graduate Medical Institute, Lahore 54000, Pakistan.; Department of Internal Medicine, Division of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore 54000, Pakistan.; Department of Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan. [email protected].

DOI: 10.3748/wjg.v30.i9.1018

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MeSH Terms: Humans, Klatskin Tumor, Treatment Outcome, Hepatectomy, Bile Duct Neoplasms, Cholangiocarcinoma, Bile Ducts, Intrahepatic, Cholangiopancreatography, Endoscopic Retrograde, Drainage