Abstract
In hilar cholangiocarcinoma, surgical resection is the only way to offer a better chance of long-term survival. The surgical procedure is determined according to the tumor extension diagnosed by several imaging modalities and liver function. Right-sided (right hepatectomy and right trisectionectomy) or left-sided hepatectomy (left hepatectomy and left trisectionectomy) with caudate lobectomy is simpler compared to central hepatectomy, being more recommended as resectional procedure. When the patient is not so old and has good liver function, extended resection with enough surgical margins is better to indicate. The surgical approach to Bismuth type I and II hilar cholangiocarcinomas should be determined according to cholangiographic tumor type. For nodular and infiltrating tumors, right hepatectomy is essential; for papillary tumor, bile duct resection with or without limited hepatectomy is adequate. When the portal vein is involved, portal vein resection and reconstruction is of clinical value; however, further studies is required for hepatic artery resection and reconstruction for involved hepatic artery.
