The rationale for surgical treatment requires the knowledge provided by T-stage of radial and longitudinal neoplastic diffusion, and of N and M stages. As described in Chap. "Preoperative Assessment of Liver Function", a correct pre-operative assessment is often difficult to achieve.
Significant data on lymph node diffusion and correlated prognosis are still lacking in the literature, except for few reports of Japanese institutions. Surgical choices are now determined mainly by local extension of disease. Nowadays resectability criteria differ from those of the past: portal and/or arterial infiltration are no longer an absolute contraindication to resection.
In the past, hilar cholangiocarcinoma was treated by biliary tract resection and limited hepatic resection. Recent data in the literature have shown that associated hepatic resection significantly increases the rate of R0 resection, with a better long-term outcome. Instead, the need to resect the caudate lobe systematically is still under debate.
Postoperative morbidity and mortality rates after major resection have decreased thanks to improvement of preoperative hepatic function (biliary drainage, portal embolisation), a better selection of patients and an upgrading of surgical techniques.
Surgical option is determined by stage and neoplastic diffusion, tailoring the type of operation that guarantees a better probability of curative resection and therefore a better prognosis.
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