Hilar cholangiocarcinoma: current management.
OBJECTIVE
To review the literature with regard to outcome of surgical management for hilar cholangiocarcinoma (Klatskin tumor).


BACKGROUND
Hilar cholangiocarcinoma is a rare tumor with a poor prognosis. Surgical resection provides the only possibility for cure. Advances in hepatobiliary imaging and surgical strategies to treat this disease have resulted in improved postoperative outcomes.


METHODS
We performed a review of the English literature on hilar cholangiocarcinoma from 1990 to 2007. This review included preoperative evaluation, surgical techniques, issues and controversies in management, prognostic variables, and considerations for future directions.


RESULTS
Complete resection remains the most effective and only potentially curative therapy for hilar cholangiocarcinoma. Negative resection margins are associated with improved outcomes, and major hepatic resections have enhanced the likelihood of R0 resection. Portal vein embolization may be indicated in selected patients before extensive hepatic resection. Staging laparoscopy should be considered to detect occult metastatic disease. Orthotopic liver transplantation might be applicable for a highly selected subgroup.


CONCLUSIONS
Surgical resection including major hepatic resection remains the mainstay of treatment of hilar cholangiocarcinoma. Additional evidence is needed to fully define the role of orthotopic liver transplantation. Improvements in adjuvant therapy are essential for improving long-term outcome.
Ito
Fumito
F
University of Wisconsin, Madison, WI 53792-7375, USA.
Cho
Clifford S
CS
Rikkers
Layton F
LF
Weber
Sharon M
SM
D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D016031:Liver Transplantation