Perihilar cholangiocarcinomas often are locally extensive and occasionally have distant metastases at diagnosis. Many of these patients are best palliated nonoperatively after an attempt at tissue diagnosis. More localized tumors, even those extending into one hepatic lobe, warrant exploration and, if possible, resection. However, the prognosis remains poor even when these tumors are resected, suggesting that new forms of adjuvant therapy are required.
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