[Surgical approach in hilar cholangiocarcinoma]

Surgery is the decisive life-prolonging treatment in patients with hilar cholangiocarcinoma. Surgery is mainly based on empiric data. Since patients without surgery have only about 6 months to survive, to achieve a high resection rate is crucial for these patients. During diagnostic workup, percutaneous transhepatic cholangiography results in the most reliable assessment of longitudinal tumor growth. The extent of the tumor is frequently overestimated leading to the consequence of excluding the patients from surgery. En-bloc resection of the tumor and the adjacent liver should be the preferred surgical approach. So far, surgical radicality (right trisegmentectomy, extended lymphadenectomy and vascular resection) has not been demonstrated to prolong survival. In our experience with 117 patients, median survival of patients following resection was 813 days, whereas patients not amenable to resection survived for 214 days only. Resection rate and the rate of curative resections were 71 and 72 %, respectively, operative mortality was 7 %. In the multivariate analysis, lymph node involvement proved to be the only prognostic marker.