Journal Review in Hepatobiliary Surgery: Resecting Perihilar Cholangiocarcinoma

Surgical resection of perihilar cholangiocarcinoma (pCCA) is one of the highest-risk elective operations performed. The obstructive jaundice suffered by patients preoperatively, central location of the tumors, and extensive nature of the resection make pCCA one of the most challenging HPB disease processes. In this episode from the HPB team at Behind the Knife, listen in on the discussion about perioperative strategies to improve outcomes for surgical resection of perihilar cholangiocarcinoma. Hosts Anish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center. He is also the associate program director of the HPB fellowship. Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center. Learning Objectives · Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach) · Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences · Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for. Papers Referenced: 1) Ribero D, Zimmitti G, Aloia TA, Shindoh J, Fabio F, Amisano M, Passot G, Ferrero A, Vauthey JN. Preoperative Cholangitis and Future Liver Remnant Volume Determine the Risk of Liver Failure in Patients Undergoing Resection for Hilar Cholangiocarcinoma. J Am Coll Surg . 2016 Jul;223(1):87-97. https://pubmed.ncbi.nlm.nih.gov/27049784/ 2) Jain AJ, Lendoire M, Haddad A, Tzeng CD, Boyev A, Maki H, Chun YS, Arvide EM, Lee S, Hu I, Pant S, Javle M, Tran Cao HS, Vauthey JN, Newhook TE. Improved Outcomes Following Resection of Perihilar Cholangiocarcinoma: A 27-Year Experience . Ann Surg Oncol . 2025 Jun;32(6):4352-4362. https://pubmed.ncbi.nlm.nih.gov/40000564/ Additional Suggested Reading Olthof PB, Erdmann JI, Alikhanov R, Charco R, Guglielmi A, Hagendoorn J, Hakeem A, Hoogwater FJH, Jarnagin WR, Kazemier G, Lang H, Maithel SK, Malago M, Malik HZ, Nadalin S, Neumann U, Olde Damink SWM, Pratschke J, Ratti F, Ravaioli M, Roberts KJ, Schadde E, Schnitzbauer AA, Sparrelid E, Topal B, Troisi RI, Groot Koerkamp B; Perihilar Cholangiocarcinoma Collaboration Group. Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible . Ann Surg Oncol . 2024 Jul;31(7):4405-4412. https://pubmed.ncbi.nlm.nih.gov/38472674/ Mueller M, Breuer E, Mizuno T, Bartsch F, et al. Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers . Ann Surg. 2021 Nov 1;274(5):780-788. https://pubmed.ncbi.nlm.nih.gov/34334638/ Ad Disclosures: Visit goremedical.com/btk to learn more about GORE® ENFORM Biomaterial. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US