Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations

Abstract

Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors.

Keywords: Biliary malignancies; Cholangiocarcinoma; Colangiocarcinoma; Criteria of unresectability; Criterios de irresecabilidad; Factores pronósticos; Klatskin tumor; Neoplasia de vía biliar; Prognostic factors; Tumor de Klatskin.