title: [Is it possible to improve survival in patients with Klatskin tumors?].
abstract: BACKGROUND
  This retrospective study was undertaken to evaluate if a high resectability rate could improve the long-term outcome of patients with proximal bile duct cancer.
  
  
  METHODS
  Between 1985 and 2001, 50 patients (34 males and 16 females) with proximal bile duct cancer were treated. The tumor site were classified according to Bismuth-Corlette's classification: 9 lesions (18%) were Bismuth type I, 23 lesions (46%) type II, 12 lesions (24%) Type IIIa, 5 lesions (10%) type IIIb and only 1 resected tumor (2%) was type IV. Thirty-six patients (72%) were considered suitable for surgery, while 14 underwent non surgical palliative procedures. Twenty patients had bile duct resection only. Ten patients had Roux-enY cholangiojejunostomy with two or three divided segmental hepatic ducts; in ten, the cholangiojejunostomy was performed with 4 or 5 divided segmental hepatic ducts. Thirteen patients had bile duct resection plus hepatectomy. Despite the curative intention of the operation, only in 19 (52.7%) patients did the histopathological examination reveal tumor-free margins.
  
  
  RESULTS
  There was no operative mortality. Overall 1-year, 3-year and 5-year survival of the entire surgical group was 61%, 22.5% and 9% respectively. In the 19 patients treated with curative intent the survival at 1,3, and 5 years was 66%, 30% and 15%, respectively, while in the palliative group it was 45%, 15% and 0%, respectively.
  
  
  CONCLUSIONS
  Only margins free from tumor may guarantee an improvement in long-term outcome. Increasing resectability improves survival and could offer a chance of better 5-year survival.
authors.affiliation: Dipartimento di Scienze Chirurgiche, Trapianti d'Organo e Tecnologie Avanzate, Centro Trapianti d'Organo, Azienda Policlinico, Università degli Studi, Catania.
authors.forename: M
authors.initials: M
authors.lastname: Veroux
authors.forename: C
authors.initials: C
authors.lastname: Madia
authors.forename: G
authors.initials: G
authors.lastname: Bruno
authors.forename: P
authors.initials: P
authors.lastname: Fiamingo
authors.forename: A
authors.initials: A
authors.lastname: D'Erminio
authors.forename: C
authors.initials: C
authors.lastname: Amodeo
authors.forename: P
authors.initials: P
authors.lastname: Caglià
authors.forename: P
authors.initials: P
authors.lastname: Veroux
authors.forename: D F
authors.initials: DF
authors.lastname: D'Amico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000601:surgery; D002277:Carcinoma / Q000145:classification / Q000401:mortality / Q000601:surgery*; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007582:Jejunostomy; D018285:Klatskin Tumor / Q000145:classification / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome