Changing concepts in perihilar cholangiocarcinoma resections and surgery

Perihilar cholangiocarcinoma (PHCC) is a malignant tumor arising from bile ducts at the hilar area. It was first described by Altemeyer et al in 1957 in Cincinnati and later in 1965 by Gerald Klatskin at Yale University. The surgical management with R0 resection represents the only potentially curative treatment for PHCC patients. The ideal surgical treatment represents a challenge for liver surgeons across the globe, and expertise in vascular reconstruction and transplantation is required. The anatomy of the liver hilum is a complex area where the proximity of portal vein bifurcation and hepatic artery branches, especially the right hepatic artery, gets an intimal relation with the bile duct confluence area. This explains frequent vascular involvement in such tumors. The modern surgical approaches in PHCC involve several topics of discussion and controversies among hepatobiliary surgeons. Some key points will be discussed in this comprehensive discussion.