[Treatment of hilar cancers]

Therapy of hilar cholangiocarcinoma is more clearly defined since progress in imaging allows accurate pretherapeutic work-up. The part of aggressive surgical resection which most of the time is a rather complex procedure is now well established since it is the only therapy which offers the chance of prolonged survival and sometimes cure. Palliative therapy which attempts to restore the bile flow is managed either conservatively by insertion of biliary endoprostheses using the percutaneous or the endoscopic approach or by intrahepatic biliary by-pass. Modalities of resectional surgery depends on the extent of the tumor. Orthotopic liver transplantation has only few selected indications because of the frequency of recurrence. Adjuvant therapy by external irradiation and chemoradiotherapy has been disappointing.