[Surgical treatment of Klatskin's tumor].

Usually primary cancer originating in the hepatic duct confluence (Klatskin Tumor) is regarded as unresectable at diagnosis and therefore percutaneously or endoscopically placed stents have been advocated. Unfortunately with these palliative modalities the median survival is only 3-6 months. However with aggressive surgical resection of the tumor 17% of five year survival have been obtained. The present paper summarizes our experience from three patients with Klatskin tumor which underwent surgery. The Klatskin tumors were Type II (one case), Type IIIa (one case) and Type IIIb (one case). The patient with tumor Type II had wide tumor excision and extrahepatic bile duct resection at the liver hilum. The patients with tumor Type III had extrahepatic bile duct resection at the liver hilum with left and right hepatectomy respectively. Reconstruction was made with Roux-en-Y biliary enteric anastomosis, the mean post operative stay was 9 days. The mean post operative survival of two patients undergoing surgery with curative intent was 21 months, in contrast to 10 months for the patient with palliative surgery. One patient is alive 22 months with no evidence of disease. Our results supports an aggressive surgical approach in patients with Klatskin tumor which should include Hepatectomy to obtain free resection margins.