title: In-continuity hepatic resection for advanced hilar cholangiocarcinoma.
abstract: BACKGROUND
  The purpose of this study was to examine outcomes of patients undergoing concomitant hepatectomy and bile duct excision for advanced Klatskin tumors.
  
  
  METHODS
  Thirty-one patients, 16 men and 15 women, with an average age of 64 years, underwent concomitant biliary and hepatic resections for Klatskin tumors. Outcomes, including complications and survival, are reported.
  
  
  RESULTS
  Fifteen patients had postoperative courses free of complications. Sixteen patients experienced a total of 50 complications; 13 patients experienced 1 or more major complications (including hemorrhage [n = 1], pneumonia [n = 5], intra-abdominal abscess [n = 8], hepatic failure [n = 3], and myocardial infarction [n = 2]). Five patients died perioperatively, 1 from adult respiratory distress syndrome and 4 from multisystem organ failure precipitated by hepatic failure. One-, 3-, and 5-year survival after resection was 69%, 33%, and 26%, respectively. American Joint Committee on Cancer stage and margin status did not impact long-term survival after resection.
  
  
  CONCLUSIONS
  Concomitant hepatic and biliary resections for Klatskin tumors carry relatively high risk but offer hope for long-term survival. This study supports in-continuity hepatectomy and extrahepatic biliary resection for advanced Klatskin tumors even when microscopically negative margins cannot be obtained.
authors.affiliation: Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, PO Box 1289, Rm. F145, Tampa, FL 33601, USA. ezervos@hsc.usf.edu
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Heidi
authors.initials: H
authors.lastname: Pearson
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Durkin
authors.forename: Donald
authors.initials: D
authors.lastname: Thometz
authors.forename: Percy
authors.initials: P
authors.lastname: Rosemurgy
authors.forename: Scott
authors.initials: S
authors.lastname: Kelley
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome