Predictive factors for survival in patients with inoperable Klatskin tumors

Biliary stenting is the treatment of choice for inoperable cholangiocarcinomas of the hilum (Klatskin tumors). The aim of this study was to define factors predicting 1) successful biliary drainage and 2) survival.

This is a retrospective study of 48 patients with Bismuth's type I-II (n=15) and III-IV (n=33) strictures who were treated endoscopically (combined with percutaneous techniques if required), aiming to obtain complete resolution of jaundice. Prognostic variables for 1) successful drainage at 30 days and 2) survival at 12 months were analyzed.

Drainage resulting in complete resolution of jaundice was obtained in 31/48 patients (65%). Baseline bilirubinemia was the only predicting factor of a successful drainage. Median survival was 202 days. The absence of a mass-type tumor or liver metastases, the absence of complications and successful drainage were identified as independent factors predicting survival at 12 months. Bilateral drainage with more than two stents was associated with a longer survival rate in patients with Bismuth III-IV tumors (271 versus 90 days) (p<0.050).

In Klatskin tumors, resolution of jaundice through an optimal stenting results in a better survival rate. Additional independent predictive factors are the absence of a mass-type tumor, liver metastases and post-drainage complications.