ABSTRACT
H epatobiliary resection for hilar cholangiocarcinoma (HC) remains a technically demanding procedure, calling for a high level of expertise in biliary and hepatic surgery. Treatment strategy for HC includes preoperative staging, perioperative managements and radical surgery. Multidetector row computed tomography (MDCT) and direct cholangiog raphy are mainstays for the precise preoperative staging. Preoperative bile replacement for patients with percutaneous transhepatic biliary drainage (PTBD) and postoperative early enteral feeding are important to reduce postoperative septic complications that potentially lead to postoperative liver failure. We have established an aggressive surgical approach for cases of HC, using PTBD, preoperative portal vein embolization (PVE) and major hepatobiliary resection. Radical surgery includes hemihepatectomy or hepatic segmentectomy, lymphadenectomy, vascular resection and reconstruction, combined pancreaticoduodenectomy in selected situations and concomitant caudate lobe resection. PVE for the liver segment to be resected, has been advocated as a useful option to induce compensatory hypertrophy of the future remnant liver. Resectional surgery for HC should be designed in terms of the tumor extent, anatomy of the hilar structure and hepatic functional reserve in each case.
