Exploring new strategies in diagnosis and treatment of hilar cholangiocarcinoma

Hilar cholangiocarcinoma is a rare form of cancer arising at the confluence of the right and left bile duct. The disease is known for its difficult diagnosis and treatment. The chapters in this thesis describe different aspects of hilar cholangiocarcinoma with the aim to improve diagnosis and treatment. Finding a suitable molecular marker is important for the development of innovative diagnostic techniques. It was found that the molecule MUC1 seems to be the most promising target for so called near-infrared optical imaging of hilar cholangiocarcinoma. To improve the surgical treatment of hilar cholangiocarcinoma the value of intraoperative frozen section analysis was investigated. It was found that frozen section analysis of the bile ducts does not improve outcome after surgery. Next, it was investigated whether postoperative staging of hilar cholangiocarcinoma can be improved. It was found that detection of lymph node micrometastases is associated with worse survival and therefore important for the prognosis after surgery. Liver transplantation has recently regained attention for the treatment of hilar cholangiocarcinoma. Excellent results have been achieved with a protocol consisting of a regimen of chemoradiotherapy followed by liver transplantation. In this thesis it was found that preoperative chemoradiotherapy is associated with a high rate of vascular complications after liver transplantation. Further, the effect of strict selection alone (without preoperative chemoradiotherapy) on the outcome of liver transplantation for hilar cholangiocarcinoma was assessed