Contemporary Management of Cholangiocarcinoma: A Narrative Review of Operative Principles and Multi-modality Therapy

Abstract Purpose of Review To review the current data on preoperative workup, operative approach, and multi-modality therapy for cholangiocarcinoma. Recent Findings Essential preoperative work-up starts with a comprehensive history and physical exam, assessing the patient’s performance status. Tumor markers and cross-sectional imaging should be obtained including computed tomography (CT) of the chest, multi-phase thin-slice CT of the abdomen and pelvis and magnetic resonance cholangiopancreatography (MRCP). Additional imaging and technical considerations vary widely based on anatomic location (intrahepatic, perihilar, distal). General operative principles include resection to negative margins and performing a regional lymphadenectomy, both of which are associated with improved outcomes. After resection, most patients receive multimodality treatment with adjuvant chemotherapy. Summary Thorough preoperative planning is needed to determine resectability for patients with cholangiocarcinoma. Multi-modality therapy should be considered, especially in the adjuvant setting, with future studies needed to evaluate the role and efficacy of neoadjuvant therapy.