Abstract
Therapeutic results of perihilar cholangiocarcinoma is gradually improved by several progress in surgical anatomy, operative procedures, perioperative management, and postoperative adjuvant therapy. However, there are a couple of issues to be resolved. Since accurate diagnosis for longitudinal extension of the tumor is often difficult before operation, intraoperative frozen section examination is usually done to confirm margin negative resection. If ductal margins are involved by cancer, surgeons should do further additional resection. However, this procedure is often fail to improve long-term clinical results. Especially, pathological significance of carcinoma in situ is still controversial. Hepatopancreatoduodenectomy is adopted for wide-spread bile duct cancer to ensure R0 resection. However, indication for elderly patients or patients with poor functional reserve of the liver is difficult. The number of the patients who underwent vascular resection is increasing to overcome the vertical infiltration of the tumor. This technique makes R0 resection possible even for the patients who should not undergo resection. However, surgeons should take attention to the relatively high mortality rates.
