Problems and countermeasures in surgical therapy of hilar cholangiocarcinoma

Surgical resection offers hilar cholangiocarcinoma patients the only chance for cure and longterm survival. Hepatectomy, extrahepatic bile duct resection, regional lymphadenectomy and hepatojejunostomy are the current treatment of choice for most patients with hilar cholangiocarcinoma. Because of the aggressive nature of hilar cholangiocarcinoma and the absenceof effective adjuvant therapy, surgical therapy still remainsa challenge to hepatopancreatobiliary surgeons even in the precise surgery era. Controversies exist over preoperative assessment and staging, the use of preoperative biliary drainage, preoperative portal vein embolization, the range of hepatic resection, portal vein resection and construction, hepatic arteriectomy and the range of lymphadenectomy. This article reviews the surgical management of hilar cholangiocarcinoma with a focus on these controversies.