Liver resection for hilar cholangiocarcinoma: In-hospital mortality and longterm survival

BACKGROUND: Extended surgical procedures are the only chance of longterm survival for patients with Klatskin tumors, but high mortality rates have been reported. The type of treatment for Bismuth type I-II carcinomas is still a matter of discussion. STUDY DESIGN: We performed a single-unit, retrospective study analyzing 36 patients who underwent resectional surgery for Klatskin tumor. RESULTS: An associated liver resection was performed in 88.9% of our patients; most of them had a major hepatectomy. The in-hospital mortality rate was 2.8%. Three- and 5-year survival rates were 40.8% and 27.2%, respectively. But the group of patients with Bismuth type I-II carcinomas undergoing hepatectomy had markedly better longterm outcomes than those undergoing hilar resection (p = 0.04): 54.5% versus 0% at 5 years, respectively; none of the patients who had only resection of bile duct confluence were alive at 2 years. Lymph node metastases were found in 38.8% of our patients; nodal involvement was not a major prognostic factor. CONCLUSIONS: Achievement of low in-hospital mortality rates is possible in specialized surgical departments. Aggressive surgical approaches can allow better longterm results in the subset of Bismuth type I-II carcinomas. (C) 2002 by the American College of Surgeons.