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Related Concept Videos

Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy01:26

Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy

This lesson explores three gastrointestinal imaging techniques: radionuclide testing, colonic transit studies, and virtual colonoscopy.
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and solid...

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Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
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Update to the role of staging laparoscopy in the assessment of resectability of perihilar cholangiocarcinoma: have

Lawrence O'Leary1, Ella Botzenhardt2, Timothy M Gilbert1

  • 1Department of Hepatobiliary Surgery, Liverpool University Hospitals NHS Foundation Trust, Mount Vernon Street, Liverpool L7 8YE, United Kingdom; Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Sherrington Building, Ashton Street, Liverpool L69 3GE, United Kingdom.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|June 12, 2025
PubMed
Summary

Accurate staging of perihilar cholangiocarcinoma is crucial. While advanced imaging like FDG PET-CT improves staging, staging laparoscopy still plays a vital role in determining surgical resectability.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Diagnostic Imaging

Background:

  • Perihilar cholangiocarcinoma (PCC) presents a significant challenge due to its poor prognosis.
  • Precise staging is essential for guiding treatment decisions between curative surgery and palliative systemic therapy.
  • Conventional CT and MRI have limitations in detecting peritoneal or liver metastases, impacting accurate staging.

Purpose of the Study:

  • To evaluate the impact of advanced imaging, specifically [18F]fluorodeoxyglucose positron emission tomography-computerised tomography (FDG PET-CT), on the staging of perihilar cholangiocarcinoma.
  • To reassess the role and diagnostic yield of staging laparoscopy in determining resectability for patients with perihilar cholangiocarcinoma in the era of advanced cross-sectional imaging.

Main Methods:

  • Retrospective analysis of 304 patients with suspected perihilar cholangiocarcinoma from 2020-2024.
  • Comparison with a matched cohort of 57 patients from 2016-2019, before widespread FDG PET-CT implementation.
  • Evaluation of conventional CT/MRI, FDG PET-CT, and staging laparoscopy in identifying inoperable disease and guiding treatment.

Main Results:

  • Between 2020-2024, conventional CT and MRI deemed 248/304 patients inoperable.
  • FDG PET-CT further excluded 16/56 patients, and staging laparoscopy excluded 5/40 patients.
  • Of 35 patients proceeding to laparotomy, 33 underwent curative resection; in the earlier cohort, 40/48 underwent resection.

Conclusions:

  • Advances in cross-sectional imaging, including FDG PET-CT, have enhanced radiological staging accuracy for perihilar cholangiocarcinoma.
  • Staging laparoscopy maintains a high diagnostic yield (1 in 8 patients excluded), justifying its continued use in assessing resectability.
  • The integration of FDG PET-CT complements, but does not entirely replace, the role of staging laparoscopy in the multidisciplinary management of perihilar cholangiocarcinoma.