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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2006

01-06-2006

Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)

Authors: Sander Dinant, MD, Michael F. Gerhards, MD, E. A. J. Rauws, MD, Olivier R. C. Busch, MD, Dirk J. Gouma, MD, Thomas M. van Gulik, MD

Published in: Annals of Surgical Oncology | Issue 6/2006

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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.
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Metadata
Title
Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)
Authors
Sander Dinant, MD
Michael F. Gerhards, MD
E. A. J. Rauws, MD
Olivier R. C. Busch, MD
Dirk J. Gouma, MD
Thomas M. van Gulik, MD
Publication date
01-06-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.05.053

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