Pearls and Pitfalls
Surgical resection remains the only opportunity for survival and is mandatory.
Do not abandon surgical resection prior to establishing definite contraindication, even when resection is technically difficult.
Surgical resection is possible in approximately 70% of patients with Bismuth type IV tumor.
Confirm accurate surgical anatomy to precisely, assess surgical indications allowing for complete surgical resection.
Surgical resection of hilar cholangiocarcinoma is required to obviate complicated biliary obstructions.
Segmental hepatectomy combined with caudate lobectomy, extrahepatic bile duct resection and extended lymphadenectomy are standard components of the surgical procedure.
Aggressive surgery inclusive of portal vein resection and reconstruction for invasion of the portal vein offers survival superior to that of conservative therapy.
Liver functions must be carefully evaluated prior to surgery as obstructive jaundice impairs hepatic function.
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Nimura, Y., Nishio, H. (2009). Perihilar Cholangiocarcinoma. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_110
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