Surgical treatment of hilar cholangiocarcinoma

Resection represents the only potential curative treatment option for hilar cholangiocarcinoma. Over the past decades the broader application of extended resection including left or right liver resections has led to an increasing surgical radicality and an improvement in the long-term results after surgical treatment. Therefore, presently en bloc hilar resection with right or left hemihepatectomy represents the standard treatment for this tumor entity. In our own strategy we prefer the concept of right trisectionectomy principally with resection of the bifurcation of the portal vein as this operative procedure leads to long-term survival rates of about 60%. By the establishment of new neoadjuvant radiochemotherapy concepts the results after liver transplantation could also be markedly improved with 5 year survival rates over 70% after treatment using the Mayo Clinic protocol. Therefore, hilar cholangiocarcinoma is now a tumor for which a better survival rate can be achieved than for a number of other gastrointestinal carcinomas.