J Korean Surg Soc.
1998 Jun;54(Suppl):1010-1017.
The Outcome of Surgical Treatment of Klatskin Tumor
- Affiliations
-
- 1Department of Surgery, Seoul National University College of Medicine.
Abstract
- The results of surgery on Klatskin tumors have improved during the era of the combined liver resection.
However, some surgeons still have a negative point of view on liver resection because of the locally
infiltrative characteristics of cancer and the high mortality and morbidity. We treated 98 patients with
a Klatskin tumor between 1990 and 1996. The mean age was 57 year, and the sex ratio (M : F) was
2.2 : 1. Among them, 27 patients (27.6%) received a combined liver resection, 11 patients (11.2%) received
a segmental resection of the extrahepatic bile duct, and the other 60 patients (61.2%) had non resective
procedures (a bypass operation, an intubational operation, or a percutaneous drainage procedure).
The mean survival of the combined liver resection group was 30.0 months-higher than those of the other
groups (17.1 months for the segmental-resection group, 14.0 months for the non resective procedures
group)(p<0.05). The cumulative 1-, 2-, and 3-year survival rates in patients undergoing a combined liver
resection were 95.5%, 83.9%, and 55.9% respectively (significantly higher than the 72.7%, 11.4%, and
0% in the patients undergoing a resection and the 41.1%, 11.4%, and 5.7% in the patients undergoing
a non resective procedures). There was no difference in the survival rates between the segmental-resection
and non resective-procedure group. In the segmental-resection group, 5 patients had a negative resection
margin, and 6 patients had a positive resection margin. The mean survivals were 18.4 and 16.0 months,
respectively (p>0.05). The morbidity rate for the combined liver resection was 74%--higher than that
for the segmental resection (45%) and for the non resective-procedure group (30%)(p<0.05). There was
one operative mortality (1.0%), the patient died due to postoperative sepsis after a U-tube intubational
operation. Based on a univariate analysis, significant prognostic factors after liver resection were lymph
node involvement, and bilirubin (>5 mg/dl) at admission. A multivariate analysis showed no prognostic
significance for either lymph node involvement or bilirubin at admission. These results indicate that
segmental resection is not a curable treatment modality and that only aggressive radical surgery, including
a hepatectomy, gives any chance of a cure for a Klatskin tumor. We conclude that combined radical
liver resection is the treatment of choice for a Klatskin tumor and that accurate preoperative diagnosis
and cautious perioperative care decrease the mortality and morbidity of a hepatectomy.