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 KhanMuhammad 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

Research output: Contribution to journalArticlepeer-review


A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Original languageEnglish
Pages (from-to)1018-1042
Number of pages25
JournalWorld Journal of Gastroenterology
Issue number9
Publication statusPublished - 7 Mar 2024


  • Bismuth-Corlette classification
  • Hepatectomy
  • Hilar cholangiocarcinoma
  • Memorial Sloan Kettering Cancer Centre Staging
  • Portal vein embolisation
  • Preoperative biliary drainage
  • Surgical resection


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