Hilar cholangiocarcinoma

Cancer of the biliary tree, including those occurring at the major biliary bifurcation (Klatskin's tumor), is an uncommon malignancy. Meaningful experience with these tumors has been limited to a few centers. Recent reports with increasing numbers of patients have allowed the construction of rational approaches to these patients. It is clear from these reports that complete resection with negative histologic margins is the only treatment that offers the possibility of long-term survival. Complete resection of hilar cholangiocarcinomas remains a technically demanding procedure requiring expertise in biliary and hepatic surgery. Patients with unresectable disease constitute a distinct majority and have traditionally been very difficult to successfully palliate and impossible to cure. A panel of hepatobiliary surgeons experienced in the management of hilar cholangiocarcinoma presented a symposium on issues relating to these patients at the recent joint American Hepato-Pancreato-Biliary Association/American Association for the Study of Liver Diseases (AHPBA-AASLD) forum in Boston, MA. The report below offers a summarization of the main points and comments raised by this panel. These summarizations are not meant as an exhaustive review and primarily reflect the opinions of the speakers based upon their experiences and interpretation of the existing literature.