[Hilar bile duct cancer: diagnostic and therapeutic strategies]

Hilar bile duct carcinoma is difficult to diagnose and requires high standards of a curative or palliative therapy. The tumor staging is performed by means of transabdominal sonography, CT scan, endoscopic retrograde cholangiography, and/or percutaneous transhepatic cholangiography and angiography. The value of cholangioscopy and endosonography must be evaluated in further studies. These procedures could improve the preoperative selection of completely resectable tumors. In addition, the mapping of tumor extension into individual hepatic segments facilitates curative operations with the smallest necessary hepatic resection which is associated with low early mortality rates and good long-term results. Nevertheless, the majority of patients can only be treated by palliation with operative, percutaneous, or endoscopic drainage. The decision of the selection of the method is individual, since there are no controlled trials for the hilar bile duct carcinoma.