Extent of liver resection for hilar cholangiocarcinoma.

Background: The extent of liver resection for hilar cholangiocarcinoma (HC) remains controversial despite extensive studies. The aim of this study was to determine the safety and efficacy of minor and major hepatectomy, selected by predetermined criteria in patients with HC. Methods: From 2000 to 2007, 187 patients with HC were studied prospectively; 138 patients underwent resection with curative intent. Minor hepatectomy was performed in 93 patients with Bismuth–Corlette type I, II or III HC without hepatic arterial or portal venous invasion, and major hepatectomy in 45 patients with type III HC with hepatic arterial or portal venous invasion, or type IV HC. Results: Overall mortality and morbidity rates were 0 and 29·7 per cent respectively, and the bile leak rate was 1·4 per cent. Actuarial 1-, 3- and 5-year survival rates were 87, 54 and 34 per cent respectively in the minor liver resection group, and 80, 42 and 27 per cent for major resection (P = 0·300). Conclusion: Minor liver resection for HC, selected by predetermined criteria, had good results. Major liver resection, which had a higher operative morbidity rate than minor resection, should be reserved for Bismuth–Corlette type III HC with vascular invasion, or type IV HC. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.