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J Korean Surg Soc. 1998 Jun;54(Suppl):1010-1017. Korean. Original Article.
Jang JY , Kim SW , Kim KH , Suh KS , Lee KU , Park YH .
Department of Surgery, Seoul National University College of Medicine.

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.

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