Abstract
In surgery for hilar cholangiocarcinoma, additional resection of >5 mm in the proximal duct is difficult after maximal or near maximal transection of the duct. Such limited resection of margin-positive proximal duct does not improve survival, even when negative margin is achieved with additional resection. To achieve R0 resection, we, hepatobiliary surgeons should always consider feasibility of more extended radical resection when general condition and liver functional reserve are stable.
Several authors reported that a positive ductal margin with carcinoma in situ, unlike with invasive carcinoma, did not have a strong adverse effect on survival. In many cases of cholangiocarcinoma with superficial spread, the survival does not depend on the complete resection of all the superficial spread but on the stage of the main lesion. Therefore, the resection of all the superficial spread does not lead to an improvement in survival in patients with advanced cholangiocarcinoma, but it may improve survival in early staged cancer such as noninvasive or minimally invasive papillary cancer.
