Cholangiocarcinoma.

Resection is indisputably associated with prolongation of survival in patients with cholangiocarcinoma and provides the only chance for cure. Equally as important is the ability to achieve microscopically clean margins at the time of resection. Liberal use of hepatic resection in conjunction with hilar vascular skeletonization may improve the ability to achieve disease-free margins and can be performed with little additional morbidity. Optimal treatment for the patient with unresectable disease is currently still debatable. Our experience, as well as others, suggests that patients who have unresectable disease by radiologic or laparoscopic evaluation are better served by nonsurgical internal biliary decompression. We currently favor nonoperative treatment with self-expandable wire mesh stents over operative biliary enteric bypass for nonresectional candidates. Patients who underwent resection who develop local recurrence with biliary obstruction also can be managed with metallic stents across the obstructed hepaticojejunostony to provide an additional period of symptomatic palliation.