Surgery for hepatic hilar tumors

Hilar resections and hemihepatectomies as surgical strategies for hilar cho langiocarcinoma achieve only limited rates of resectability and radicality. Principles of surgical oncology have to be applied in order to increase th e numbers of patients undergoing resection as well as their long-term survi val. Due to the anatomical architecture of the hepatic hilum and side-speci fic variations within the biliary tree, right trisectorectomy and principal portal vein resection have the potential to comply with basic rules of sur gical oncology, i.e. wide tumor-free margins and a no-touch dissection tech nique. In our experience, 5-year survival after formally curative right tri sectorectomy and portal vein resection is 65 % in spite of advanced tumor s tages. Resection of the entire biliary tract without dissection of the tumo r is possible by combining total hepatectomy, partial pancreatoduodenectomy and liver transplantation. However, even this procedure does still not ful ly prevent tumor cell dissemination. So far, a putative alteration of tumor cell kinetics due to posttransplant immunosuppressive treatment results in an increased rate of implantation metastases.