[Surgical strategy for hilar cholangiocarcinoma: comparison between Japan and Europe]

Hilar cholangiocarcinoma is very difficult to treat, and resection of the tumor remains challenging. In Japan, accurate diagnosis of tumor extension and meticulous evaluation of liver function are routinely performed before surgery for hilar cholangiocarcinoma. Biliary drainage is a prerequisite part of presurgical management, and portal vein embolization is performed in many high-volume centers. In contrast, in Europe preoperative diagnosis of tumor extension is "rough" with fewer diagnostic modalities employed compared with Japan. Assessment of liver function is omitted, and therefore the procedure employed for resection is sometimes determined according to the surgeon's intuition based on intraoperative inspection. The general consensus is that resection is the best method for the treatment of cholangiocarcinoma, although the procedure differs from institution to institution in Europe as well as in Japan. Overall, Japan is the most advanced in the surgical treatment of hilar cholangiocarcinoma, including the diagnosis of tumor extension, perioperative management, and surgery. Japanese surgeons have taken the lead in biliary cancer surgery and should continue to make efforts to improve patient survival in this intractable disease.