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Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)

¹ Department of Surgery, Academic Medical Center, P.O. Box 227001100 DE Amsterdam The Netherlands
² Department of Gastroenterology, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam The Netherlands

Correspondence: Address correspondence and reprint requests to: Thomas M. van Gulik, MD; E-mail: t.m.vangulik{at}amc.uva.nl

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.

Key Words: Hilar cholangiocarcinoma • Hepatectomy • Liver • Surgery • Mortality • Survival

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