[Surgical treatment of hilar cholangiocarcinoma]

From the therapeutic and diagnostic viewpoints, percutaneous transhepatic biliary drainage (PTBD) is crucial for the preoperative management of hilar cholangiocarcinoma. Pertinent multiple catheterizations using PTBD produce effective relief of jaundice and accurate diagnosis of cancer extent. Endoscopic retrograde biliary drainage is contraindicated for preoperative biliary decompression. To reduce posthepatectomy liver failure, an accurate preoperative assessment of hepatic functional reserve is essential. Indocyanine green test has been used conventionally. Although this test underestimates liver function under conditions of jaundice, it is still the most practical and reliable. Preoperative portal vein embolization is an effective method for preventing posthepatectomy liver failure and extending an indication of extensive liver resection. Liver resection for hilar cholangiocarcinoma is now popular in Japan, and combined en bloc resection of the caudate lobe has become general. However, the procedure of and indication for hepatectomy is not yet standardized. Further investigations are needed to produce more rational surgical procedure for hilar cholangiocarcinoma.