Long-term outcome in patients with advanced Klatskin-Tumors undergoing operative and/or endoscopic therapy

Abstract

Aims: Because of the late presentation of symptoms, hilar cholangiocellular carcinomas are usually diagnosed in later stages and in general therapy concept can not be curative. Palliative treatment strategies include endoscopic retrograde cholangio-pancreatography, percutaneous transhepatic biliary drainage or surgery. Patients and methods: 96 consecutive patients underwent treatment for malignant hilar bile duct tumors during a period of 11 years. To assess prognostic factors and clinical outcome the patients were reviewed retrospectively. Results: 76/96 patients were treated only by endoscopic procedures using ERC (n=45) and/or PTBD (n=31). 20/96 patients were initially treated by surgery (n=2 R0 / n=18 R1). All 18 R1-resected patients had recurrent obstruction and later on required ERC or PTBD. Median survival time in all 96 patients was 650 days, and correlated significantly with bismuth stage and bilirubin levels at the time of primary diagnosis. Average survival time of R1-resected patients in Bismuth stage III/IV was 1403/511 days compared to 442/274 days in non resected patients. Conclusions: Median survival of the patients depends on the tumor stage and bilirubin levels. Patients treated by ERC and PTCD seem to have a shorter overall survival than operated patients. Future studies will determine whether a more aggressive surgical approach in advanced cases or, alternatively, endoscopic treatment with photodynamic therapy can actually reveal a benefit or might even be performed subsequently.