Surgery for patients with perihilar cholangiocarcinoma: Improvements in work-up and outcomes

Perihilar cholangiocarcinoma (PHC) arises from the bile duct epithelium at the liver hilum. Major surgery is the only curative treatment for patients with PHC and typically consists of a liver resection combined with bile duct resection. Due to its anatomic location, treatment of PHC is complex and work-up for resection requires a multidisciplinary approach. The aim of this thesis was to contribute to improvements in treatment and outcomes of patients with PHC.
Part I of this thesis focusses on several challenges that are encountered during work-up of patients with cholangiocarcinoma, including determination of resectability and improvement of the future remnant liver volume and function. As approximately 15% of the patients who undergo resection for PHC have benign disease at pathological assessment, preoperative confirmation of diagnosis is a major challenge.
In Part II of this thesis, outcomes of treatment in patients with PHC are investigated. Since major differences in outcomes exist between centers across the world, two literature studies summarize differences in perioperative approaches and outcomes. Additionally, differences in outcomes after left and right-sided liver resection are discussed, as well as the influence of different policies on concomitant portal vein resection. Finally, in a pilot study we demonstrated that percutaneous CT-guided irreversible electroporation for patients with locally advanced or recurrent PHC is feasible.