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Treatment of localized cholangiocarcinoma: Adjuvant and neoadjuvant therapy and prognosis

Christopher D Anderson, MD, FACS
Keith E Stuart, MD
Section Editors
Kenneth K Tanabe, MD
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


Cholangiocarcinomas are rare malignancies arising from the epithelial cells of the intrahepatic and extrahepatic bile ducts. They are characterized by early lymph node and distant metastases.

Surgery provides the only possibility for a cure, but only a minority of patients present with early stage disease and are considered candidates for resection. Distal cholangiocarcinomas (figure 1) have the highest resectability rates while proximal (both intrahepatic and perihilar) tumors have the lowest. Resectability rates for cholangiocarcinomas have increased over time, due in part to more aggressive operative strategies and broadened criteria for resectability. However, the majority of cases recur despite complete surgical resection. (See "Surgical resection of localized cholangiocarcinoma".)

Following complete surgical resection, relapse patterns are both local and distant metastases (typically hepatic or peritoneal recurrence) [1,2]. These data provide the rationale for exploring adjuvant systemic chemotherapy as well as radiation therapy-based regimens after resection.

Adjuvant and neoadjuvant treatments for cholangiocarcinoma and prognosis for patients with localized, potentially resectable disease will be reviewed here. Epidemiology, pathology, classification, staging, clinical presentation, and diagnosis, as well as surgical management of localized disease, treatment for locally advanced disease, and systemic therapy for metastatic disease are discussed elsewhere. (See "Clinical manifestations and diagnosis of cholangiocarcinoma" and "Epidemiology, pathogenesis, and classification of cholangiocarcinoma" and "Surgical resection of localized cholangiocarcinoma" and "Treatment options for locally advanced cholangiocarcinoma" and "Systemic therapy for advanced cholangiocarcinoma".)


Imaging is used to diagnose and accurately stage the tumor and may include contrast-enhanced multidetector row computed tomography (MDCT) of the abdomen, cholangiopancreatography (magnetic resonance, endoscopic, transhepatic), and possibly positron emission tomography (PET). (See "Clinical manifestations and diagnosis of cholangiocarcinoma", section on 'The staging workup'.)

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