Surgical palliation for unresectable hilar cholangiocarcinoma.

The majority of patients who present with hilar cholangiocarcinoma will have incurable disease and require only palliation. Efficient relief of disabling symptoms is required with minimal morbidity and mortality and can be achieved by either surgical or non-operative options. A review of the indications, anatomical considerations and surgical techniques is presented. Segment III cholangio-jejunostomy is the most frequently used surgical bypass procedure and in those patients with an expected survival of more than 6 months, surgical palliation offers good quality and long-lasting palliation. There is a need for randomized controlled data to define the optimal role of surgical palliation in this difficult disease.