Local Resection Without Hepatectomy

In the last decades, surgical treatment of hilar cholangiocarcinoma has moved toward liver surgery in association with biliary resection in order to increase radicality and to achieve better survival results. In this chapter, results of isolated biliary resection in comparison with those of biliary and hepatic resection and its actual indications are analyzed in detail, considering our own experience and the literature presently available. Local resection is not an adequate treatment for hilar cholangiocarcinoma involving the bile duct confluence (Bismuth-Corlette type II or more) and associated liver resection should be always recommended. In Bismuth-Corlette type Ihilar cholangiocarcinoma benefits of survival by association of biliary and liver resection have been reported, but further studies are necessary. At present, local resection should be scheduled only for small papillary Klatskin tumor without bile duct confluence involvement (type I) and confined to the bile duct wall (Tis and T1). Accurate preoperative staging is mandatory to correctly assess tumor extension and to plan adequate treatment strategy. Extension of treatment should always be decided according to patient conditions after an extensive evaluation of functional, volumetric and anaesthesiological parameters.