title: [Hilar cholangiocarcinoma].
abstract: Surgical resection has been reported to be only hope for cure for the patients with hilar cholangiocarcinoma. Therefore, first of all, radical surgical resection should be considered to be a therapeutic option for hilar cholangiocarcinoma as much as possible. In preoperative staging for hilar cholangiocarcinoma, various extensive patterns of cancer such as the involvements of bile duct, portal vein, hepatic artery and lymph node etc, should be evaluated in each patient. As most patients are associated with obstructive jaundice at presentation, liver function has to be evaluated by appropriate tests for deciding the suitable surgical procedure. When the future remnant liver volume is less than 40% or severe liver functional damage exists or greater surgical stress is expected, preoperative portal vein embolization might have to be selected. On the other hand, if hilar cholangiocarcinoma involves limited region of the hilar bile duct confluence, parenchyma preserving hepatectomy such as S1 resection and S1 + S4 resection should be selected for avoiding the occurrence of liver failure. Combined portal vein resection should be done for the case of the cancer involvement of the portal vein without hesitation to improve the prognosis. However, hepatic artery resection and reconstruction in the involved case should be carefully performed only in severely selected cases. By using several useful pre-operative and intra-operative therapeutic modalities, hilar cholangiocarcinoma should be surgically resected with curative intent and without increasing surgical morbidity and mortality rates.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Akira
authors.initials: A
authors.lastname: Togawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Sawada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ambiru
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008111:Liver Function Tests; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011169:Portal Vein / Q000601:surgery