Surgical treatment for perihilar cholangiocarcinoma: the changing definition in the updated General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract

Abstract

An update edition of General Rule for Clinical and Pathological Studies on Cancer of the Biliary Tract has proposed the new term, "perihilar cholangiocarcinoma", which has been defined more specifically, compared to the previous version. Based on this new definition, tumors developing from the large duct (extrahepatic type) and those developing from the intrahepatic bile duct are managed together in the same tumor staging scheme. However, the latter is characterized as higher incidences of left-sided predominance and vascular invasion. Therefore, the proportion of left hepatic trisectionectomy or vascular invasion may rise in the era of the new definition. Institutional indication of these procedures may affect the overall resectability. Meanwhile, according to the nationwide survey, the mortality rate after left hepatic trisectionectomy or hepatobiliary resection is higher (>5%) than anticipated. Thus, hepatectomy for perihilar cholangiocarcinoma remains challenging.