title: Changing trends in the management of Klatskin tumor.
abstract: OBJECTIVE
  To evaluate the long-term outcome of a multidisciplinary approach for advanced Klatskin tumor involving the hepatic hilus.
  
  
  METHODS
  A retrospective analysis was undertaken in 110 patients between 1993 and 2003. The patients were divided into Group A (n=42) and Group B (n=58). Group A patients underwent local excision of the tumor and Group B patients underwent combined tumor and liver resection with or without resection of the regional vascular structures. On admission, all patients underwent percutaneous transhepatic biliary drainage. Where hepatectomy was planned, portal vein branch ligation and transection was done ipsilateral to the liver lobe where the tumor was present. An arterial catheter was introduced into the hepatic artery at the end of the surgery, for adjuvant locoregional immunochemotherapy, which was carried out in all patients. The second-stage resectional surgery was carried out 35 days later.
  
  
  RESULTS
  The overall mean survival for Group A patients was 29 months (range 14 to 76). The mean disease-free survival was 28 months (range 10-52). Five-year survival rate was 5% and five-year disease-free survival was 0%. The overall mean survival for Group B patients was 39 months (range 28 to 79). The mean disease-free survival was 32 months (range 17-72). Five-year survival rate was 20% and five-year disease-free survival was 10%.
  
  
  CONCLUSIONS
  The concept of a multidisciplinary approach has significantly improved survival in patients with a grave disease like Klatskin tumor.
authors.affiliation: Department of Surgical Oncology, Henry Dunant Hospital, Athens, Greece. iasg@iasg.org
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: Gurusharan
authors.initials: G
authors.lastname: Singh
authors.forename: E
authors.initials: E
authors.lastname: Bardaxoglou
authors.forename: G
authors.initials: G
authors.lastname: Dedemadi
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: J
authors.initials: J
authors.lastname: Nestoriois
authors.forename: A
authors.initials: A
authors.lastname: Malliotakis
authors.forename: M
authors.initials: M
authors.lastname: Pedonomou
authors.forename: M
authors.initials: M
authors.lastname: Safioleas
authors.forename: E K
authors.initials: EK
authors.lastname: Solomou
authors.forename: L
authors.initials: L
authors.lastname: Grigorakos
authors.forename: P
authors.initials: P
authors.lastname: Vrachnos
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality* / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors