OPPORTUNITIES FOR SURGICAL TREATMENT IN CHOLANGIOCARCINOMA

Introduction. Cholangiocarcinomas are rare tumors but with high morbidity and mortality. The literature presents different treatment strategies and options, however, the only confirmed curative treatment for cholangiocarcinoma is surgery. The aim of the study. Realization of a literature review on existing surgical treatment options and their effectiveness in cholangiocarcinoma Material and methods. The evaluated publications were collected from the databases: HINARI, Medline, Google Sсholаr, Сambridge Journals Online, PubMed Embase, Cochrane databases. The search was limited to 2000 – 2024 years, with 47 bibliographic sources selected for relevance. Results. Surgical options in cholangiocarcinoma are determined by: the clinical condition of the patient, the location and extent of the tumor, including parenchymal and vascular involvement, the functional volume of the remaining liver, and the absence or presence of metastases. The type and extent of resection depend on the location of the tumor. Practiced options: intrahepatic tumor – customized partial hepatectomy combined with extended lymphadenectomy: perihilar, parapancreatic and celiac, perihilar tumor – complete resection of the extrahepatic biliary tree combined with extended hepatectomy including segment I, resection of the bifurcation of the portal vein and N1/N2 lymphadenectomy, distal biliary tree tumor – pancreatoduodenectomy combined with complete resection of the extrahepatic bile duct below the hepatic confluence and N1/N2 lymphadenectomy. Conclusions. Individualized multimodal management in cholangiocarcinoma needs to be established by a multidisciplinary team. R0 resection is the main modality of curative treatment. Achieving R0 requires extensive liver resection, which in the case of large multifocal or unifocal tumors presents a risk of postoperative liver failure. Surgical interventions in several stages, with the use of PVE and ALPPS procedures in the first stage, which facilitate the expansion of the remaining liver volume, as well as biliary drainage in the case of cholangitis or a small liver volume, contribute to the reduction of morbidity and mortality in the pathology.