Current and future trends in management and treatment of Klatskin tumour

Abstract

First resected by Brown in Melbourne in 1954, Klatskin tumors were defined as an adenocarcinoma of the hepatic duct at the bifurcation within the porta hepatis. They now, usually, include upper-third cancers of the common bile duct down to the junction with the cystic duct. They are also known as: proximal cancer of the biliary tract, cancer of the biliary confluence, cancer of the confluence of biliary tract, cancer of superior biliary confluence, and malignant stricture of biliary confluence. They must be differentiated from cholangiocarcinomas, which are adenocarcinomas involving intrahepatic bile ducts. Recently, the American College of Pathologists has insisted on using the term cholangiocarcinoma only for tumours of the intrahepatic bile ducts. Similary, cancer of the hepatic hilus can be defined by its location in front of the bifurcation of the portal vein, and can include cancer of the gallbladder and of the cystic duct. As the prognosis is so different, particularly for resection, this nomenclature is of little use. Cancer is often suspected by the diagnosis of a stricture to the upper third of the common bile duct. Diagnosis can only be made by the histology of the operative specimen. Sclerosing cholangitis can mimic such a cancer. Operability