Surgical management and prognostic factors of hilar cholongiocarcinoma: experience with 68 patients at the Ghent university Hospital

From may 1992 to december 2006, 68 patients with Klatskin tumor were evaluated in our institution. Clinicopathological data were analyzed and univariate and multivariate analyses carriede out to determine significant prognostic factors affecting morbidity and mortality. Mean age was of 53,4+/-12 years. M/F ratio was of 46/22. After a median FU of 28 months (1-84), 11/68 (16%) of patients were non respectable (group A) and treated with palliative transtumoral stenting. The others 57 patients (group B) underwent surgery : n=5 for BYsmuth type II; n=20 for type IIIa; n=23 for type IIIb and n=9 for type IV. Median survival was of 6 months in non resected patients vs. 32 months in group B (p = 0,001). R0 resection was achived in 41/57 (72%) patients. Median survival was of 48 m in R0 vs. 10 m in R1-2 resection (p = 0,003). In-hospital mortality was of 3.5%. Overall morbidity rate was of 3.5%. Factors related to a shorter survival were identified as: Lymphatic and perineural invasiveness, R1-2 resection, AJCC stage, overall 3 & 5 y patient survival was of 45% and 22% respectively. Surgical approach for Klatskin tumor is the only chance for long-term survival with acceptable surgical mortality rate. In our experience, radical oncological surgery was possible in more than 70% of cases leading to a significant survival. Perineural and lymphatic involvement combined to a R1-R2 resection correlated with shorter survival.