| Theme |
Hilar and Intrahepatic Cholangiocarcinoma |
| Title |
The Diagnosis and Surgical Strategy for Hilar Cholangiocarcinoma |
| Author |
Satoshi Hayama |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Satoshi Hirano |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Akihiro Matsunaga |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Jo Matsumoto |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Kentaro Kato |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Takahiro Tsuchikawa |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Toshiaki Shichinohe |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| Author |
Eiichi Tanaka |
Department of Gastroenterological SurgeryII, Hokkaido University Graduate School of Medicine |
| [ Summary ] |
It is critical to evaluate the longitudinal extension and vertical invasion of hilar cholangiocarcinoma by several diagnostic modalities for planning the treatment. The longitudinal extension refers to the longuitudinal spread of the tumor along the biliary tree, and the vertical invasion refers to the infiltration into the surrounding tissues including the adjacent hepatic artery and portal vein. On the basis of these evaluations, choice of appropriate surgical procedure, and hepatic ductal division at the separating limits from the vasculature are mandatory to ensure negative ductal margins. Major hepatectomy for patients with obstructive jaundice to obtain negative ductal margins increases the risk of postoperative hepatic failure. Therefore, strict evaluation for postoperative prognosis and precise perioperative management such as reduced jaundice by suitable biliary decompression as well as hypertrophy of and functional transition to the future remnant liver by preoperative portal embolization are vital. |