Hilar Cholangiocarcinoma

Abstract

EDITORIALHilar cholangiocarcinoma (HC) is a rare tumor (0.74-1.05 ×100000 inhabitants), representing 3% of gastrointestinal cancers [1,2] . It accounts for 2/3 of the tumors of the biliary tract [1] . Although HC is frequently discussed at surgical scientific meetings and arouses great interest, it has far fewer citations than other HPB cancers and several questions regarding the condition remain unanswered in the medical literature.Untreated, the prognosis of HC is very poor. Surgery is the only therapy that offers the possibility of cure but is technically very complex [1,3] . A few years ago, the number of patients operated and resected was very low, and 5-year survival was mediocre. With recent improvements in the therapeutic strategies applied by multidisciplinary teams comprising radiologists, gastroenterologists, surgeons and oncologists, survival rates in the different series currently range from 25% to 45% [3,4] . A group of experts devoted to HC (pathologists, gastroenterologists, radiologists, surgeons and oncologists) have reviewed and updated every open question in HC in this special issue focusing in the following areas of the management and treatment of patients with HC:Prof. Valls et al [5] has updated diagnostic methods in HC: Imaging methods have improved diagnostic sensitivity and specificity, especially for determining biliary and vascular involvement. These methods include multidetector computed tomography, Cholangio-magnetic resonance, percutaneous transhepatic cholangioscopy, positron emission tomography computed tomography and staging by laparoscopy reviewed by Prof. Rotellar et al [6] . Prof. Suarez-Munoz et al [7] have updated the classification/staging systems in HC: There have been several pro- AbstractHilar cholangiocarcinoma (HC) is a rare tumor. It accounts for 2/3 of the tumors of the biliary tract. Untreated, prognosis is very poor. Surgery is the only therapy that offers the possibility of cure but is technically very complex. With recent improvements in the therapeutic strategies applied by multidisciplinary teams, survival rates in the different series currently range from 25% to 45%. A group of experts devoted to HC (pathologists, gastroenterologists, radiologists, surgeons and oncologists) have reviewed and updated every open question in HC in a special issue. Key words: Cholangiocarcinoma; Hilar; Perihilar; Klatskin; Surgery; Cancer; Review Core tip: Most remarked avances are: imaging methods have improved diagnostic sensitivity and specificity, especially for determining biliary and vascular involvement; there have been several proposals to improve the classic Bismuth-Corlette classification; preand post-operative care; technical aspects trying to obtain a R0 resection: widespread use of liver resection, resection of segment I and venous and arterial resection, refinement of post-operative histology and adjuvant therapies.