[Intrahepatic cholangiocarcinoma - current perspectives and treatment algorithm].

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Interventional radiology

Background:

• Cholangiocarcinoma (CCC) is a prevalent liver malignancy often diagnosed late.
• Radical surgical resection is the primary curative treatment for CCC.
• Accurate assessment of liver function and future liver remnant (FLR) is crucial for surgical planning.

Purpose of the Study:

• To review current treatment strategies for cholangiocarcinoma.
• To highlight advancements in surgical and interventional techniques for managing CCC.
• To discuss adjuvant therapy considerations post-resection.

Main Methods:

• Review of surgical resection techniques including hepatectomy and lymphadenectomy.
• Discussion of liver function assessment and FLR estimation.
• Overview of interventional radiology procedures like TACE and TARE.
• Evaluation of novel surgical approaches such as ALPPS.
• Consideration of radiofrequency ablation (RFA) for specific cases.

Main Results:

• Novel techniques like ALPPS expand resectability in previously unresectable CCC cases.
• RFA demonstrates efficacy for small intrahepatic cholangiocarcinoma (IHCC) in cirrhotic livers.
• TACE/TARE offer palliative or neoadjuvant options for unresectable CCC, often combined with systemic therapy.
• Adjuvant therapy post-curative resection is a potential consideration based on recent trial data.

Conclusions:

• Surgical resection remains the cornerstone of curative CCC treatment.
• Interventional and advanced surgical techniques significantly improve management options for advanced CCC.
• Multidisciplinary approaches are essential for optimizing outcomes in cholangiocarcinoma care.