Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1998 Oct;187(4):358-64.
doi: 10.1016/s1072-7515(98)00207-5.

Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation

S Iwatsuki  1 , S Todo, J W Marsh, J R Madariaga, R G Lee, I Dvorchik, J J Fung, T E Starzl
Affiliations

Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation

S Iwatsuki et al. J Am Coll Surg. 1998 Oct.

Abstract

Background: Because of the rarity of hilar cholangiocarcinoma, its prognostic risk factors have not been sufficiently analyzed. This retrospective study was undertaken to evaluate various pathologic risk factors which influenced survival after curative hepatic resection or transplantation.

Methods: Between 1981 and 1996, 72 patients (43 males and 29 females) with hilar cholangiocarcinoma underwent hepatic resection (34 patients) or transplantation (38 patients) with curative intent. Medical records and pathologic specimens were reviewed to examine the various prognostic risk factors. Survival was calculated by the method of Kaplan-Meier using the log rank test with adjustment for the type of operation. Survival statistics were calculated first for each kind of treatment separately, and then combined for the calculation of the final significance value.

Results: Survival rates for 1, 3, and 5 years after hepatic resection were 74%, 34%, and 9%, respectively, and those after transplantation were 60%, 32%, and 25%, respectively. Univariate analysis revealed that T-3, positive lymph nodes, positive surgical margins, and pTNM stage III and IV were statistically significant poor prognostic factors. Multivariate analysis revealed that pTNM stage 0, I, and II, negative lymph node, and negative surgical margins were statistically significant good prognostic factors. For the patients in pTNM stage 0-II with negative surgical margins, 1-, 3-, and 5-year survivals were 80%, 73%, and 73%, respectively. For patients in pTNM stage IV-A with negative lymph nodes and surgical margins, 1-, 3-, and 5-year survivals were 66%, 37%, and 37%, respectively.

Conclusions: Satisfactory longterm survivals can be obtained by curative surgery for hilar cholangiocarcinoma either with hepatic resection or liver transplantation. Redefining pTNM stage III and IV-A is proposed to better define prognosis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survivals after hepatic resection (Hx), orthotopic liver transplantation (OLT), and organ cluster transplantation (OLT-CL).
Figure 2
Figure 2
Survival of patients with T3 tumors was significantly lower than for those with T-is, 1, and 2.
Figure 3
Figure 3
Survival of patients with positive lymph nodes (N1) was significantly lower than for those with negative lymph nodes (NO).
Figure 4
Figure 4
Survival of patients with stage III and IV were significantly lower than for those with less than stage III tumors.
Figure 5
Figure 5
Survival of patients with negative microscopic margins was significantly better than for those with positive margins.
See this image and copyright information in PMC

References

    1. Akemeier WA, Gall EA, Zinninger MM, Hoxworth PL. Sclerosing carcinoma of the major intrahepatic bile ducts. Arch Surg. 1957;75:459–461. - PubMed
    1. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. Am J Med. 1965;38:241–256. - PubMed
    1. Tompkins RK, Thomas D, Wile A, Longmire WP. Prognostic factors in the bile duct carcinoma: analysis of 96 cases. Ann Surg. 1981;194:447–457. - PMC - PubMed
    1. Ringe B, Wittekind C, Bechstein WO, et al. The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989;209:88–89. - PMC - PubMed
    1. Hadjis NS, Blenkharn JI, Alexander N, et al. Outcome of radical surgery in hilar cholangiocarcinoma. Surgery. 1990;107:597–604. - PubMed

Publication types

MeSH terms