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Annals of Surgical Oncology

, Volume 13, Issue 6, pp 872–880 | Cite as

Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)

  • Sander Dinant
  • Michael F. Gerhards
  • E. A. J. Rauws
  • Olivier R. C. Busch
  • Dirk J. Gouma
  • Thomas M. van Gulik
Article

Abstract

Background

Treatment of hilar cholangiocarcinoma (Klatskin tumors) has changed in many aspects. A more extensive surgical approach, as proposed by Japanese surgeons, has been applied in our center over the last 5 years; it combines hilar resection with partial hepatectomy for most tumors. The aim of this study was to assess the outcome of a 15-year evolution in the surgical treatment of Klatskin tumors.

Methods

A total of 99 consecutive patients underwent resection for hilar cholangiocarcinoma in three 5-year time periods: periods 1 (1988–1993; n = 45), 2 (1993–1998; n = 25), and 3 (1998–2003; n = 29). Outcome was evaluated by assessment of completeness of resection, postoperative morbidity and mortality, and survival.

Results

The proportion of margin negative resections increased significantly from 13% in period 1 to 59% in period 3 (P < .05). Two-year survival increased significantly from 33% ± 7% and 39% ± 10% in periods 1 and 2 to 60% ± 11% in period 3 (P < .05). Postoperative morbidity and mortality were considerable but did not increase with this changed surgical strategy (68% and 10%, respectively, in period 3). Lymph node metastasis was, next to period of resection, also associated with survival in univariate analysis.

Conclusions

Mainly in the last 5-year period (1998–2003), when the Japanese surgical approach was followed, more hilar resections were combined with partial liver resections that included segments 1 and 4, thus leading to more R0 resections. This, together with a decrease in lymph node metastases, resulted in improved survival without significantly affecting postoperative morbidity or mortality.

Keywords

Hilar cholangiocarcinoma Hepatectomy Liver Surgery Mortality Survival 

Notes

Acknowledgments

The authors thank Professor Y. Nimura (Division of Surgical Oncology, Nagoya University Hospital) for his collaboration during the last 5 years. They also thank Professor H. Obertop (Department of Surgery, Academic Medical Center) for his contributions to this study.

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Copyright information

© The Society of Surgical Oncology, Inc. 2006

Authors and Affiliations

  • Sander Dinant
    • 1
  • Michael F. Gerhards
    • 1
  • E. A. J. Rauws
    • 2
  • Olivier R. C. Busch
    • 1
  • Dirk J. Gouma
    • 1
  • Thomas M. van Gulik
    • 1
  1. 1.Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of GastroenterologyAcademic Medical CenterAmsterdamThe Netherlands

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