Klatskintumoren — Vergleich zwischen Resektion und Drainage

Summary

Since the development of surgical techniques has allowed the curative resection of hilar cholangiocarcinoma with reasonably low postoperative mortality, the question that arises is whether radical surgery influences patient survival. This study is based on 63 consecutive patients treated at our institution for hilar cholangiocarcinoma. According to the Bismuth classification, in 77% a stage III or IV tumor was found. In nine patients no surgical procedure was performed because of metastases or age. A total of 54 patients underwent laparotomy. No resection was possible in 21 of these cases (39%) because of irresectability or previously undetected metastases. Nineteen patients underwent bile duct resection alone and 14 bile duct resection in combination with liver resection; 53% of these resections were curative (R0). The median survival times were: R0, 28 months; Rl, 22 months, and R2, 6 months. There was a significant difference between overall R0 and Rl/2 resections (0.0001, log rank). After treatment with a stent alone, the median survival was 9 months, after laparotomy and stent 6 months, after bile duct resection alone 17 months, and for combined liver and bile duct 18 months (0.0001 log rank). Our results suggest that R0 resection is imperative to achieve improved survival in hilar cholangiocarcinoma. Bile duct resection alone will usually allow this only in Bismuth stage I or II tumors. In contrast, stage III and IV tumors usually require bile duct and liver resection if the tumors are at all resectable.