Palliation: Hilar cholangiocarcinoma

Table 1 Criteria for non-resectability of hilar cholangiocarcinoma

Bilateral hepatic duct involvement up to the secondary biliary radicles (Bismuth type IV)

Encasement or occlusion of the main portal vein (relative)

Unilateral tumor extension to secondary biliary radicles (Bismuth type III) with contralateral portal vein or hepatic artery involvement or encasement

Hepatic lobar atrophy with contralateral portal vein or hepatic artery involvement or encasement

Hepatic lobar atrophy with contralateral tumor extension to the secondary biliary radicles

Available from Aljiffry et al^[6].

Table 2 Unilateral vs bilateral drainage for hilar cholan-giocarcinoma

	Unilateral	Bilateral	P
No. of pts	79	78	-
Stent insertion (%)	88.6	76.9	0.041
Successful drainage (%)	81.0	73.0	0.049
Early complication (%)	18.9	26.9	0.026
Survival (d)	140	142	0.482

Available from De Palma et al[16].

Table 3 Malignant hilar obstruction-1 stent or 2

	Group A	Group B	Group C
n	32	29	37
Early cholangitis	6%	0%	32%
30-d mortality	0%	3%	30%
Survival (d)	145	225	45

Group A: One lobe opacified and the same lobe drained; Group B: Both lobes opacified and both lobes drained; Group C: Both lobes opacified with just one lobe drained. Available from Chang et al[18].

Table 4 Computed tomography/magnetic resonance cholangio-pancreatography -Guided Selective Unilateral Stenting

Ref.	Hintze et al [25]	Freeman et al [26]	De Palma et al[16]
No. of pts	35	35	61
Stent	Plastic	Metal	Metal
Tech. success (%)	100	100	97
Effective drain (%)	86	77	97
Early cholangitis (%)	6	0	5
Median patency (d)	-	165	169
Median survival (d)	300	150	140

Table 5 Photodynamic therapy as an adjunct to biliary stenting: Improved survival

	Year	No. of pts	Median survival (mo)		P value
			Stenting alone	Stenting with PDT
Ortner et al[56]	2003	39	3	16	< 0.0001
Cheon et al[57]	2004	47	10	18	0.0143
Zoepf et al[58]	2005	32	7	21	0.0109

PDT: Photodynamic therapy.