Surgery for hilar cholangiocarcinoma--the German experience

Up to 1989, 581 resections of hilar cholangiocarcinomas had been reported in the world literature by 40 authors, the largest experience originating from Professor Rudolf Pichelmayr's group in Hannover. Over the past decade, other centers in Germany have also adopted the more aggressive surgical approach instead of palliative biliary drainage, or even continued to develop further strategies, as the reported long-term results remained disappointing. In Berlin, we started a program of oncological hepatobiliary surgery in 1988. Since then, 104 patients have undergone resections of hilar cholangiocarcinomas, including 14 patients in whom a procedure combining liver transplantation and partial pancreatoduodenectomy, the so-called extended bile duct resection, was performed. Although the rate of curative resections increased significantly after this procedure, a comparable favorable effect with respect to survival figures was not evident. We observed the highest postoperative 5-year survival rates (59%) in the group of patients who had undergone right trisegmentectomy. Preoperative ipsilateral biliary decompression, i.e., of the remnant lobe, and arterial platinum coil embolization of the lobe to be resected are means to achieve a wider applicability of this method.