Guidelines
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2024; 30(9): 1018-1042
Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1018
National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma
Faisal Saud Dar, Zaigham Abbas, Irfan Ahmed, Muhammad Atique, Usman Iqbal Aujla, Muhammad Azeemuddin, Zeba Aziz, Abu Bakar Hafeez Bhatti, Tariq Ali Bangash, Amna Subhan Butt, Osama Tariq Butt, Abdul Wahab Dogar, Javed Iqbal Farooqi, Faisal Hanif, Jahanzaib Haider, Siraj Haider, Syed Mujahid Hassan, Adnan Abdul Jabbar, Aman Nawaz Khan, Muhammad Shoaib Khan, Muhammad Yasir Khan, Amer Latif, Nasir Hassan Luck, Ahmad Karim Malik, Kamran Rashid, Sohail Rashid, Mohammad Salih, Abdullah Saeed, Amjad Salamat, Ghias-un-Nabi Tayyab, Aasim Yusuf, Haseeb Haider Zia, Ammara Naveed
Faisal Saud Dar, Irfan Ahmed, Muhammad Yasir Khan, Sohail Rashid, Department of Hepatopancreatic Biliary Surgery & Liver Transplant, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan
Zaigham Abbas, Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Karachi 75600, Sindh, Pakistan
Irfan Ahmed, University of Aberdeen, Aberdeen B24 3FX, United Kingdom
Muhammad Atique, Department of Pathology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan
Usman Iqbal Aujla, Osama Tariq Butt, Ahmad Karim Malik, Ammara Naveed, Department of Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan
Muhammad Azeemuddin, Department of Radiology, Aga Khan University, Karachi 74800, Pakistan
Zeba Aziz, Department of Oncology, Hameed Latif Hospital, Lahore 54000, Pakistan
Abu Bakar Hafeez Bhatti, Haseeb Haider Zia, Division of Hepatopancreatic Biliary Surgery & Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan
Tariq Ali Bangash, Amer Latif, Department of Hepatopancreatic Biliary Surgery & Liver Transplant, Shaikh Zayed Hospital and Post Graduate Medical Institute, Lahore 54000, Pakistan
Amna Subhan Butt, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Abdul Wahab Dogar, Department of Liver Transplant, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat 66020, Pakistan
Javed Iqbal Farooqi, Department of Medicine & Gastroenterology, Lifecare Hospital and Research Centre, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan
Faisal Hanif, Department of Hepatopancreatobiliary & Liver Transplant, Bahria International Hospital, Lahore 54000, Pakistan
Jahanzaib Haider, Siraj Haider, Department of Surgery, Hepatopancreatobiliary & Liver Transplant, Dow University of Health Sciences, Karachi 74800, Pakistan
Syed Mujahid Hassan, Department of Gastroenterology, Hepatology & Nutrition, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat 66020, Pakistan
Adnan Abdul Jabbar, Department of Oncology, Dr. Ziauddin Hospital, Karachi 74800, Pakistan
Aman Nawaz Khan, Department of Radiology, Rehman Medical Institute, Peshawar 25000, Pakistan
Muhammad Shoaib Khan, Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi 46000, Pakistan
Nasir Hassan Luck, Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi 75500, Pakistan
Kamran Rashid, Rashid Nursing Home and Cancer Clinic, Rashid Nursing Home and Cancer Clinic, Rawalpindi 46000, Pakistan
Mohammad Salih, Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad 44000, Pakistan
Abdullah Saeed, Department of Radiology, Pakistan Kidney and Liver Institute & Research Centre, Lahore 54000, Pakistan
Amjad Salamat, Department of Gastroenterology and Hepatology, Quaid-e-Azam International Hospital, Rawalpindi 44000, Pakistan
Ghias-un-Nabi Tayyab, Department of Gastroenterology and Hepatology, Post Graduate Medical Institute, Lahore 54000, Pakistan
Aasim Yusuf, Department of Internal Medicine, Division of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore 54000, Pakistan
Author contributions: Abbas Z, Ahmed I, Atique M, Azeemuddin M, Aziz Z, Bhatti ABH, Butt AS, Dogar AW, Farooqi JI, Hanif F, Haider J, Hassan SM, Jabbar AA, Khan AN, Latif A, and Rashid K wrote separate sections of the guidelines according to their specialty; Aujla UI, Butt OT, Dar FS, Khan MY, Malik AK, Naveed A, and Saeed A worked extensively on the first draft of the manuscript; Rashid S provided input during the initial planning of the manuscript; Bangash TA, Haider S, Khan MS, Luck NH, Salih M, Salamat A, Tayyab GN, Yusuf A, and Zia HH provided intellectual input during the consensus conference; All authors provided critical feedback to help shape the final manuscript.
Conflict-of-interest statement: The authors report having no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ammara Naveed, MBBS, Assistant Professor, Department of Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, DHA Phase VI Lahore, Lahore 54000, Pakistan. ammara.naveed@pkli.org.pk
Received: November 13, 2023
Peer-review started: November 13, 2023
First decision: December 7, 2023
Revised: January 3, 2024
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: March 7, 2024
Core Tip

Core Tip: Consensus among national hepatobiliary experts convened at the Pakistan Kidney and Liver Institute & Research Centre emphasized the complexity of hilar cholangiocarcinoma, advocating a multidisciplinary approach for optimal patient management. Diagnostic protocol includes imaging like computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, while endoscopic retrograde cholangiopancreatography plays an important role in tissue acquisition. Surgical resection remains the best curative treatment option. For unresectable cases, liver transplantation is considered under strict selection criteria. Preoperative biliary drainage and portal vein embolisation decisions may be needed for selective cases. Adjuvant chemotherapy addresses the risk of recurrence. The role of Immunotherapy is emerging and offers improved survival for irresectable hilar cholangiocarcinoma.