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Updated: Jun 29, 2026
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
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.
Introduction:
Perihilar cholangiocarcinoma has poor prognosis. Accurate staging is paramount in stratifying patients to appropriate treatment: curative surgery or palliative systemic anti-cancer therapy. Conventional CT and MRI are insufficiently sensitive at identifying peritoneal or liver metastases. Since 2020, [18F]fluorodeoxyglucose positron emission tomography-computerised tomography (FDG PET-CT) has been incorporated into staging, prompting reassessment of staging laparoscopy's role in determining resectability.
Methods:
This retrospective study reviewed patients referred with suspected perihilar cholangiocarcinoma to a UK hepatobiliary centre between 2020 and 2024 (n = 304). Those with potentially resectable disease on conventional CT and MRI were compared to a matched 2016-2019 cohort (n = 57).
Results:
Between 2020 and 2024, CT and MRI identified inoperable disease in 248/304 patients. FDG PET-CT further excluded 16/56 patients. Staging laparoscopy in 40 patients excluded 5. Among 35 proceeding to laparotomy, 33 completed curative-intent resection. In 2016-2019, all 57 underwent staging laparoscopy, excluding 9. Of 48 proceeding to laparotomy, 40 completed resection.
Conclusions:
Advances in cross-sectional imaging, including FDG PET-CT, have improved radiological staging. However, at 1-in-8, the diagnostic yield of staging laparoscopy remains high, justifying its continued role in evaluating resectability.
