Surgical resection has been reported to be only hope for cure for the patients with
hilar cholangiocarcinoma. Therefore, first of all, radical surgical resection should be considered to be a therapeutic option for
hilar cholangiocarcinoma as much as possible. In preoperative staging for
hilar cholangiocarcinoma, various extensive patterns of
cancer such as the involvements of bile duct, portal vein, hepatic artery and lymph node etc, should be evaluated in each patient. As most patients are associated with
obstructive jaundice at presentation, liver function has to be evaluated by appropriate tests for deciding the suitable
surgical procedure. When the future remnant liver volume is less than 40% or severe liver functional damage exists or greater surgical stress is expected, preoperative portal vein embolization might have to be selected. On the other hand, if
hilar cholangiocarcinoma involves limited region of the hilar bile duct confluence, parenchyma preserving
hepatectomy such as S1 resection and S1 + S4 resection should be selected for avoiding the occurrence of
liver failure. Combined portal vein resection should be done for the case of the
cancer involvement of the portal vein without hesitation to improve the prognosis. However, hepatic artery resection and reconstruction in the involved case should be carefully performed only in severely selected cases. By using several useful pre-operative and intra-operative therapeutic modalities,
hilar cholangiocarcinoma should be surgically resected with curative intent and without increasing surgical morbidity and mortality rates.