Hilar Cholangiocarcinoma with Portal Vein Involvement

Abstract

Hilar cholangiocarcinoma (HC) arises at the hepatic hilum, where the confluence of the major lobar bile ducts form the common hepatic duct and the adjacent portal veins and hepatic arteries enter the liver. When feasible, resection is the mainstay of therapy, as no other current treatments are effective. En-bloc extrahepatic bile duct resection, ipsilateral hepatectomy, regional lymphadenectomy, and Roux-en-Y hepaticojejunostomy are the principal operation recommended for HC, though liver transplantation is also an option for selected patients with unresectable Bismuth–Corlette type IV tumors. The most important goal of surgery is margin-negative resection, which may require resection and reconstruction of portions of portal vein and/or hepatic artery. Vascular reconstruction adds vessel-specific morbidity to such operations and increases the risk of perioperative death, particularly when arterial reconstruction is undertaken. Technical considerations related to portal venous and hepatic arterial resection and reconstruction are reviewed in this chapter, as well as current controversies related to surgery for hilar cholangiocarcinoma.