Intrahepatic Cholangiocarcinoma: Expert consensus statement

Sharon M. Weber, Dario Ribero, Eileen M. O'Reilly, Norihiro Kokudo, Masaru Miyazaki, Timothy M. Pawlik

Research output: Contribution to journalArticle

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Abstract

An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of intrahepatic cholangiocarcinoma (ICC) in order to establish practice guidelines and to agree on consensus statements. The treatment of ICC requires a coordinated, multidisciplinary approach to optimize survival. Biopsy is not necessary if the surgeon suspects ICC and is planning curative resection, although biopsy should be obtained before systemic or locoregional therapies are initiated. Assessment of resectability is best accomplished using cross-sectional imaging [computed tomography (CT) or magnetic resonance imaging (MRI)], but the role of positron emission tomography (PET) is unclear. Resectability in ICC is defined by the ability to completely remove the disease while leaving an adequate liver remnant. Extrahepatic disease, multiple bilobar or multicentric tumours, and lymph node metastases beyond the primary echelon are contraindications to resection. Regional lymphadenectomy should be considered a standard part of surgical therapy. In patients with high-risk features, the routine use of diagnostic laparoscopy is recommended. The preoperative diagnosis of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) by imaging studies is extremely difficult. Surgical resection remains the mainstay of treatment, but survival is worse than in HCC alone. There are no adequately powered, randomized Phase III trials that can provide definitive recommendations for adjuvant therapy for ICC. Patients with high-risk features (lymphovascular invasion, multicentricity or satellitosis, large tumours) should be encouraged to enrol in clinical trials and to consider adjuvant therapy. Cisplatin plus gemcitabine represents the standard-of-care, front-line systemic therapy for metastatic ICC. Genomic analyses of biliary cancers support the development of targeted therapeutic interventions.

Original languageEnglish
Pages (from-to)669-680
Number of pages12
JournalHPB
Volume17
Issue number8
DOIs
Publication statusPublished - Aug 1 2015

Fingerprint

Cholangiocarcinoma
Therapeutics
gemcitabine
Biliary Tract Neoplasms
Biopsy
Survival
Standard of Care
Lymph Node Excision
Practice Guidelines
Positron-Emission Tomography
Laparoscopy
Cisplatin
Hepatocellular Carcinoma
Neoplasms
Lymph Nodes
Tomography
Magnetic Resonance Imaging
Clinical Trials
Neoplasm Metastasis
Liver

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Weber, S. M., Ribero, D., O'Reilly, E. M., Kokudo, N., Miyazaki, M., & Pawlik, T. M. (2015). Intrahepatic Cholangiocarcinoma: Expert consensus statement. HPB, 17(8), 669-680. https://doi.org/10.1111/hpb.12441

Intrahepatic Cholangiocarcinoma : Expert consensus statement. / Weber, Sharon M.; Ribero, Dario; O'Reilly, Eileen M.; Kokudo, Norihiro; Miyazaki, Masaru; Pawlik, Timothy M.

In: HPB, Vol. 17, No. 8, 01.08.2015, p. 669-680.

Research output: Contribution to journalArticle

Weber, SM, Ribero, D, O'Reilly, EM, Kokudo, N, Miyazaki, M & Pawlik, TM 2015, 'Intrahepatic Cholangiocarcinoma: Expert consensus statement', HPB, vol. 17, no. 8, pp. 669-680. https://doi.org/10.1111/hpb.12441
Weber SM, Ribero D, O'Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic Cholangiocarcinoma: Expert consensus statement. HPB. 2015 Aug 1;17(8):669-680. https://doi.org/10.1111/hpb.12441
Weber, Sharon M. ; Ribero, Dario ; O'Reilly, Eileen M. ; Kokudo, Norihiro ; Miyazaki, Masaru ; Pawlik, Timothy M. / Intrahepatic Cholangiocarcinoma : Expert consensus statement. In: HPB. 2015 ; Vol. 17, No. 8. pp. 669-680.
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