title: Limits of Surgical Resection for Bile Duct Cancer.
abstract: BACKGROUND
  Perihilar cholangiocarcinoma is the most frequent cholangiocarcinoma and poses difficulties in preoperative evaluation. For its therapy, often major hepatic resections as well as resection and reconstruction of the hepatic artery or the portal vein are necessary. In the last decades, great advances were made in both the surgical procedures and the perioperative anesthetic management. In this article, we describe from our point of view which facts represent the limits for curative (R0) resection in perihilar cholangiocarcinoma.
  
  
  METHODS
  Retrospective data of a 6-year period (2008-2014) was collected in an SPSS 22 database and further analyzed with focus on the surgical approach and the postoperative as well as histological results.
  
  
  RESULTS
  Out of 96 patients in total we were able to intend a curative resection in 73 patients (76%). In 58/73 (79.5%) resections an R0 situation could be reached (R1 n = 14; R2 n = 1). 23 patients were irresectable because of peritoneal carcinosis (n = 8), broad infiltration of major blood vessels (n = 8), bilateral advanced tumor growth to the intrahepatic bile ducts (n = 3), infiltration of the complete liver hilum (n = 2), infiltration of the gallbladder (n = 1), and liver cirrhosis (n = 1). Patients with a T4 stadium were treated with curative intention twice, and in each case an R1 resection was achieved. Most patients with irresectable tumors can be suspected to have a T4 stadium as well. In a T3 situation (n = 6) we could establish five R0 resections and one R1 resection.
  
  
  CONCLUSIONS
  The limit of surgical resection for bile duct cancer is the advanced tumor stage (T stadium). While in a T3 stadium an R0 resection is possible in most cases, we were not able to perform an R0 resection in a T4 stadium. From our point of view, early T stadium cannot usually be estimated through expanded diagnostics but only through surgical exploration.
authors.affiliation: General, Visceral and Transplant Surgery, Johannes Gutenberg-University Hospital of Mainz, Mainz, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bartsch
authors.affiliation: General, Visceral and Transplant Surgery, Johannes Gutenberg-University Hospital of Mainz, Mainz, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinrich
authors.affiliation: General, Visceral and Transplant Surgery, Johannes Gutenberg-University Hospital of Mainz, Mainz, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
keywords: Bile duct cancer; Klatskin tumor; Limits; Perihilar cholangiocarcinoma; Resectability; Surgery