Extrahepatic Cholangiocarcinoma: What the Surgeon Needs to Know
Radiographics. 2018 Nov-Dec;38(7):2019-2020. doi: 10.1148/rg.2018180067.
Itri JN1, de Lange EE1.
The full digital presentation is available online. Both intra- and extrahepatic cholangiocarcinomas (CCAs) have a relatively poor prognosis, with the prognosis being slightly better for patients with extrahepatic tumors, with a 30% 5-year survival rate for patients with tumors that are localized. A variety of methods have been used to categorize extrahepatic CCAs on the basis of location and growth pattern. Extrahepatic CCAs are categorized as hilar/perihilar (eg, Klatskin tumor) or distal (eg, tumor arising distal to the origin of the cystic duct). The hilar/perihilar tumors originate at the confluence of the left and right hepatic ducts and form approximately 50%–60% of all CCAs, while distal tumors account for approximately 10%–20% of cases. Although surgery is the most effective treatment of CCAs, only a minority of tumors are considered resectable, as most are too advanced for resection at the time of patient presentation. However, resectability rates have increased over the years, largely owing to the use of aggressive operative strategies, broadening of the resectability criteria, and improved imaging techniques for preoperative tumor assessment and surgical planning. In this online presentation, we discuss the role of MRI in determining the surgical resectability of CCAs, focusing specifically on extrahepatic tumors, with particular attention to hilar/perihilar lesions.