ORIGINAL PAPERS

A single-center experience in the management of Altemeier-Klatskin tumors

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Konstantinos Tsalis¹, Konstantinos Vasiliadis¹, Vasilios Kalpakidis², Emmanuel Christoforidis¹, Antonios Avgerinos³, Dimitrios Botsios¹, Angelos Megalopoulos¹, Anna Bettina Haidich⁴, Dimitrios Betsis¹

1) Fourth Surgical Department, Aristotle University.
2) Department of Radiology and
3) Department of Gastroenterology, General Regional Hospital "George Papanikolaou".
4) Laboratory of Hygiene, Medical School, Aristotle University, Thessaloniki, Greece

Abstract

The aim of this study is to present our experience in the management of patients with Altemeier-Klatskin tumor, with particular focus on the risk factors that influence survival after tumor resection.

Methods. Over a 15-year period, 37 patients with hilar cholangiocarcinoma were managed in our Department. The mean age of the patients was 62.5 years. Twenty-one patients were treated by palliative measures while sixteen patients had resection of the tumor and 11 of these had negative histological margins. An associated major hepatectomy was performed in six. In parallel, certain risk factors that could influence survival were analyzed.

Results. The resectability rate was 43.2%. The 30-day mortality rate was 7.4% and postoperative morbidity was 37.5%. The sites of the resected tumors were Bismuth-Corlette type I lesions in 3 patients, type II in 6, type IIIa in 2, and type IIIb in 5. The median survival of patients undergoing resection was significantly higher than of patients not undergoing resection (p<0.001). Furthermore, patients with R0 resection and histological clear margins experienced significantly superior survival than patients with R1 resection and positive margins (p=0.001, and p<0.001 respectively). Resections resulting in cancer-positive margins did not portend a survival benefit.

Conclusion. Negative surgical margins, tumor differentiation and infiltrating macroscopic appearance, were statistically significant prognostic factors. Our findings emphasize that complete resection of the tumor with negative histological margins offers the best possibility of long-term survival, and that the addition of hepatectomy to biliary resection results in a greater number of patients with margin negative resections.

Key words
Hilar cholangiocarcinoma - Klatskin tumor - hepatectomy - intrahepatic anastomosis