Abstract
Objectives. To evaluate, in hilar cholangiocarcinoma (HCCA), the prognostic impact of specific preoperative radiologic parameters on resectability, metastases, and yield of laparoscopy, and to evaluate the currently used staging systems. Methods. Consecutive patients with HCCA presenting in our center from January 2003 through August 2010 were evaluated. Suspicion on lymph node metastasis, portal vein and hepatic artery involvement, lobar atrophy, and proximal extent of ductal invasion was scored. The prognostic value of these parameters for predicting resectability, yield of diagnostic laparoscopy, likelihood of metastatic disease, R0 resection, and survival was assessed. The Bismuth-Corlette classification and MSKCC staging system were evaluated. Results. Of all 289 evaluated patients, 158 patients (55%) had unresectable disease based on cross-sectional imaging studies or diagnostic laparoscopy; 131 patients (45%) underwent exploration. 83 patients (64%) underwent resection, of whom 67 (87%) had a radical (R0) resection. Suspicious lymph nodes and involvement of the hepatic artery were important prognostic factors for resectability. Predictive power of the evaluated staging systems was limited. Conclusions. Current staging systems predict resectability, but there is room for improvement. Hepatic artery involvement and nodal status might be important factors for prediction of resectability and should be considered in future staging systems.
Highlights
Hilar cholangiocarcinoma (HCCA), or Klatskin tumor, is a rare cancer arising at the confluence of the right and left hepatic ducts
Since we found no advantage of laparoscopic ultrasound for the staging of lymph nodes and hepatic artery involvement, laparoscopic ultrasound was not used in the current study [14]
The 48 patients who were deemed unresectable during laparotomy had metastases (n = 13), positive lymph nodes outside the hepatoduodenal ligament (n = 15), or locally advanced tumor (n = 20)
Summary
Hilar cholangiocarcinoma (HCCA), or Klatskin tumor, is a rare cancer arising at the confluence of the right and left hepatic ducts. Since the BC classification was not able to predict resectability [4, 5], the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a new presurgical T-staging system in 1998 [6] that took into account portal vein involvement, lobar atrophy, and ductal extent of the tumor. This staging system was further modified in 2001 [7]. This system, is based on pathological criteria and, is not applicable in the preoperative setting
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