Evolution of surgery for Klatskin tumor demonstrates improved outcome: a single center analysis

The rapid development of the Chinese economy has enabled advances to be made in the surgical treatment of Klatskin tumors. We retrospectively reviewed the surgical outcomes of hilar cholangiocarcinoma at a single Chinese center, focusing on the surgical procedures, radicality of the operative procedure (R0, R1 or R2), survival rates, and independent prognostic factors. This objective of the analysis was to evaluate improvements in perioperative and long-term outcomes of surgical resection of Klatskin tumors.

Between January 1998 and December 2007, 131 consecutive patients underwent operative resection for Klatskin tumor at Tianjin Medical University General Hospital, Tianjin, China. Clinicopathological data were analyzed to assess their impact on survival.

The overall 3- and 5-year survival rates were 46% and 22%, respectively. Median overall survival for the entire cohort was 35 months. Survival increased progressively between 1998 and 2007. Preoperative biliary drainage represents a safe strategy before hepatectomy for hilar cholangiocarcinoma in patients with jaundice. Patients who underwent liver resection achieved significantly higher R0 rates than those undergoing biliary resection only. Preoperative total bilirubin level, lymph node metastasis and degree of radicality (R1 and 2 vs R0) were found to be independent factors that negatively affected overall survival.

Surgical resection remains the mainstay of treatment for hilar cholangiocarcinoma. Development in surgical equipment, techniques, and perioperative management have increased long-term survival after curative liver resection, despite the more aggressive surgical procedures that are being performed.