Resectability criteria for Klatskin tumours: The “Black Run” of liver surgery

The surgical management of Klatskin tumours remains, to date, the only available treatment-option with curative intent, and with a potential influence on overall survival1. Despite all the modern progresses in preoperative diagnostic imaging, the resectability judgement criteria are for hilar cholangiocarcinomas still not standardized; Klatskin tumour surgery remains one of the most challenging for liver surgeons. There seems to be no consensus about resectability criteria of Klatskin tumours especially related to preoperative work-up and intra-operative findings. One of the hottest topics of this type of surgery, which is still a matter of debate, is how to assess resectability of hilar cholangiocarcinomas and which are reasonable criteria to judge such tumours unresectable. Also treatment outcomes are not so enthusiastic while the overall survival of R0 resected patients is about 20% at 5 years2,3,4,5. Furthermore, the problems of resectability are, for these tumours, also related to the "residual volume-function" after resection.