Current Updates in the Surgical Management of Hilar Cholangiocarcinoma

Choi, Sae Byeol; Kim, Kyung Sik

Abstract

Cholangiocarcinomas originate from the bile duct mucosa and can occur at any level of the biliary tract. Approximately 40 to 60% of cases are found at the hilar level.-Currently, a curative surgical resection is the only treatment method. The surgical treatments of a hilar cholangiocarcinoma are challenging but the diagnostic accuracy has improved with the better preoperative imaging and noninvasive diagnostic techniques. Using the percutaneous transhepatic choledochoscope,-direct visualization of the extent and possible invasion of the tumor is possible, which provides information for determining the extent of the resection. During an endoscopic examination, it is also possible to-pathologically confirm a carcinoma and drain biliary system to relieve an obstruction. Portal vein embolization to increase the volume of the future remaining liver has been attempted in steps of-accomplishing an extended surgical resection of hilar cholangiocarcinoma.- The 5-year survival of hilar cholangiocarcinoma is still poor, ranging from 20~40% after a curative resection with-a median survival of 12-16 months. A R0 resection is the most important prognostic factor that affects the survival significantly . The choice of surgical procedure is determined by the location of the tumor. In general, unilobar involvement even with ipsilateral encasement of the hepatic artery or portal vein branch, and/or ipsilateral secondary biliary radicals with associated lobar atrophy are considered resectable. In carefully selected candidates,-an extended hepatic resection with a concomitant en bloc resection of the vascular structures and accompanied by a reconstruction along with a biliary excision has been advocated for complex hilar tumors to attain some survival benefit through a R0 resection. We review the recent trends in various diagnostic methods and surgical treatments for hilar cholangiocarcinoma.