title: Contemporary surgical approach to hilar cholangiocarcinoma.
abstract: BACKGROUND
  The diagnostic and therapeutic approach to hilar cholangiocarcinoma and thus the prognosis have changed significantly over the last two decades. Nonetheless, hilar cholangiocarcinoma presents a complex surgical challenge.
  
  
  OBJECTIVE
  To assess the outcome of the radical approach for the management of types III and IV hilar cholangiocarcinoma.
  
  
  METHODS
  We conducted a retrospective single-center study. Preoperative diagnosis was based on ultrasound, computed tomography and selective percutaneous cholangiography without tissue diagnosis. Surgery was radical and included en-bloc liver, extrahepatic biliary tree and hilar lymph nodes resection, followed by biliary reconstruction with hepaticojejunostomy.
  
  
  RESULTS
  Fifteen patients (mean age 49 years, range 24-72) were managed accordingly. Anatomic classification of the biliary involvement was Bismuth-Corlette type IIIA (n=4), type IIIB (n=3) and type IV (n=8). The surgical procedures performed included four right hepatic lobectomies, five left hepatic lobectomies and six trisegmentectomies (all extended to the caudate lobe). Complete negative resection margins (RO) were accomplished in 12 cases (80%). Regional lymph node metastases were detected in five cases. There were two perioperative mortalities. Long-term follow-up (mean 30 months, range 6-72) revealed local recurrences in two cases, distant metastases in three, and both local and distant in two cases. Eleven patients are alive and 6 are without evidence of disease. The overall 2- and 5-year survival is 78% and 38% respectively.
  
  
  CONCLUSIONS
  In selected patients the aggressive surgical approach to hilar cholangiocarcinoma is justified and can result in long-term survival.
authors: Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: Michail
authors: M
authors: Papoulas
authors: Nir
authors: N
authors: Lubezky
authors: Yaacov
authors: Y
authors: Goykhman
authors: Isaac
authors: I
authors: Kori
authors: Erwin
authors: E
authors: Santo
authors: Richard
authors: R
authors: Nakache
authors: Joseph
authors: J
authors: Klausner
authors: Menahem
authors: M
authors: Ben-Haim
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome