Abstract
Although surgical treatment for hilar cholangiocarcinoma had been a high risk procedure, safety and curability has been improved as preoperative biliary drainage and portal vein embolization has become widely used and as the mode of tumor spread has become clear. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. Strategy including preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy, i. e. extended hemihepatectomy and right or left trisegmentectomy, without mortality in patients with hilar bile duct cancer. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Extended resection, such as hepatopancreatoduodenectomy or combined vascular resection and reconstruction has been applied to the selected patients with widespread tumors. As a result, extended hemihepatectomy offers a chance for cure of hilar bile duct cancer with resectability of 74.5%, curability rate of 64% without liver failure and mortality. A 5-year survival rate was 33.9%, and postoperative adjuvant chemotherapy should be considered for patients with lymph node metastasis and with poor prognosis.
