title: Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival.
abstract: BACKGROUND
  Extended surgical procedures are the only chance of longterm survival for patients with Klatskin tumors, but high mortality rates have been reported. The type of treatment for Bismuth type l-II carcinomas is still a matter of discussion.
  
  
  METHODS
  We performed a single-unit, retrospective study analyzing 36 patients who underwent resectional surgery for Klatskin tumor.
  
  
  RESULTS
  An associated liver resection was performed in 88.9% of our patients; most of them had a major hepatectomy. The in-hospital mortality rate was 2.8%. Three- and 5-year survival rates were 40.8% and 27.2%, respectively. But the group of patients with Bismuth type I-II carcinomas undergoing hepatectomy had markedly better longterm outcomes than those undergoing hilar resection (p = 0.04): 54.5% versus 0% at 5 years, respectively; none of the patients who had only resection of bile duct confluence were alive at 2 years. Lymph node metastases were found in 38.8% of our patients; nodal involvement was not a major prognostic factor.
  
  
  CONCLUSIONS
  Achievement of low in-hospital mortality rates is possible in specialized surgical departments. Aggressive surgical approaches can allow better longterm results in the subset of Bismuth type I-II carcinomas.
authors.affiliation: Department of Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo, TO, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Muratore
authors.forename: Roberto
authors.initials: R
authors.lastname: Polastri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.forename: Paolo
authors.initials: P
authors.lastname: Massucco
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods / Q000401:mortality; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome