Tailored care in resectable perihilar cholangiocarcinoma

Surgical resection of perihilar cholangiocarcinoma offers a distinct benefit in long-term survival, but it is a complex procedure. The tumour may extend into segmental branches of the bile ducts, or involve the portal vein and/or hepatic artery. Curative-intent resection requires a combined extrahepatic bile duct and partial liver resection, sometimes including a portal vein resection and reconstruction. These extended procedures are associated with a high risk of postoperative mortality, even more so because many patients present with obstructive jaundice. Selecting the optimal treatment in patients with perihilar cholangiocarcinoma is a trade-off between opportunities for long-term survival against the danger of procedural risks: surgery offers a chance for long-term survival or cure, but perioperative complications may cause abrupt death. This thesis aimed to provide recommendations and clinical decision rules for tailored care in patients with resectable perihilar cholangiocarcinoma.