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Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)

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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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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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Authors and Affiliations

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

    Sander Dinant MD, Michael F. Gerhards MD, Olivier R. C. Busch MD, Dirk J. Gouma MD & Thomas M. van Gulik MD

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

    E. A. J. Rauws MD

Authors
  1. Sander Dinant MD
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  2. Michael F. Gerhards MD
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  3. E. A. J. Rauws MD
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  4. Olivier R. C. Busch MD
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  5. Dirk J. Gouma MD
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  6. Thomas M. van Gulik MD
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Corresponding author

Correspondence to Thomas M. van Gulik MD.

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Dinant, S., Gerhards, M.F., Rauws, E.A.J. et al. Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor). Ann Surg Oncol 13, 872–880 (2006). https://doi.org/10.1245/ASO.2006.05.053

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  • DOI: https://doi.org/10.1245/ASO.2006.05.053

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