Hilar Cholangiocarcinoma

• Hilar cholangiocarcinoma is a complex disease for which the only curative treatment is complete surgical resection.

• Staging and evaluation of resectability of hilar cholangiocarcinoma require preoperative determination of tumor extent to the biliary tract, portal vein, and hepatic artery.

• R0 resection is of utmost importance and has been associated with improved survival.Major hepatic resection is needed to achieve complete longitudinal and radial negative margins. Portal vein involvement and bilateral biliary extent to secondary branches are not contraindications for curative intent surgery.

• Preoperative portal vein embolization and selective or total biliary drainage are available tools to increase resectability rate and minimize surgical morbidity.

• Orthotopic liver transplantation can benefit a subgroup of patients with unresectable small hilar cholangiocarcinoma.

• Palliative therapies include surgical biliary drainage procedures, endoscopic orpercutaneous bile duct stenting, and local ablative methods (such as chemotherapy and photodynamic therapy).