Surgical Considerations for Biliary and Perihilar Neoplasms

Biliary tract malignancies, including perihilar and distal cholangiocarcinoma and gallbladder cancer, are anatomically complex tumors for which resection remains the only curative treatment. Optimal management requires multidisciplinary evaluation, careful patient selection, and meticulous preoperative planning, including biliary drainage and assessment of the future liver remnant. Major hepatectomy with en bloc bile duct excision is the standard approach for peri-hilar cholangiocarcinoma, while pancreaticoduodenectomy is required for distal tumors. Gallbladder cancer is frequently diagnosed incidentally, and definitive re-resection improves outcomes for T1b or greater tumors.