Progress and Challenges in Distinguishing Malignant from Benign Causes of Liver Hilum Obstruction

This study retrospectively analyzed consecutive patients who underwent surgery for hilar obstruction and aimed to determine factors distinguishing benign from malignant causes and long-term outcomes after resection. Among 182 patients, 14% had benign disease. Significant differences were found in ca19-9 levels and cross-sectional imaging features between malignant and benign strictures. Preoperative biopsy had moderate accuracy. Grade 3-4 complications occurred more frequently in patients with malignant strictures. Postoperative complications of chronic portal hypertension and recurrent cholangitis were observed in over 10% of patients, regardless of disease etiology.