Cholangiocarcinoma: The Current Status of Surgical Options including Liver Transplantation.

Simple Summary: Cholangiocarcinoma (CCA) poses a substantial threat as it ranks as the second most prevalent primary liver tumor. This review reports comprehensively describe the surgical strategies available for treating CCA, including the preoperative measures and interventions, alongside the current options about liver resection and OLT. CCAs are aggressive primary liver tumors with an average 5-year survival of 5% in nodal-positive disease. The primary surgical approach should aim for complete R0 resection along with lymphadenectomy for right staging. However, even in patients who have undergone tumor re-section, the five-year survival rate remains low at around 25%. On the other hand, the combined neoadjuvant OLT showed an increase in the five-year survival rate when compared to surgical resection. Cholangiocarcinoma (CCA) poses a substantial threat as it ranks as the second most prevalent primary liver tumor. The documented annual rise in intrahepatic CCA (iCCA) incidence in the United States is concerning, indicating its growing impact. Moreover, the five-year survival rate after tumor resection is only 25%, given that tumor recurrence is the leading cause of death in 53–79% of patients. Pre-operative assessments for iCCA focus on pinpointing tumor location, biliary tract involvement, vascular encasements, and metastasis detection. Numerous studies have revealed that portal vein embolization (PVE) is linked to enhanced survival rates, improved liver synthetic functions, and decreased overall mortality. The challenge in achieving clear resection margins contributes to the notable recurrence rate of iCCA, affecting approximately two-thirds of cases within one year, and results in a median survival of less than 12 months for recurrent cases. Nearly 50% of patients initially considered eligible for surgical resection in iCCA cases are ultimately deemed ineligible during surgical exploration. Therefore, staging laparoscopy has been proposed to reduce unnecessary laparotomy. Eligibility for orthotopic liver transplantation (OLT) requires certain criteria to be granted. OLT offers survival advantages for early-detected unresectable iCCA; it can be combined with other treatments, such as radiofrequency ablation and transarterial chemoembolization, in specific cases. We aim to comprehensively describe the surgical strategies available for treating CCA, including the preoperative measures and interventions, alongside the current options regarding liver resection and OLT. [ABSTRACT FROM AUTHOR]