Predictive factors for survival in patients with inoperable Klatskin tumors.
OBJECTIVE
Biliary stenting is the treatment of choice for inoperable cholangiocarcinomas of the hilum (Klatskin tumors). The aim of this study was to define factors predicting 1) successful biliary drainage and 2) survival.


METHODS
This is a retrospective study of 48 patients with Bismuth's type I-II (n=15) and III-IV (n=33) strictures who were treated endoscopically (combined with percutaneous techniques if required), aiming to obtain complete resolution of jaundice. Prognostic variables for 1) successful drainage at 30 days and 2) survival at 12 months were analyzed.


RESULTS
Drainage resulting in complete resolution of jaundice was obtained in 31/48 patients (65%). Baseline bilirubinemia was the only predicting factor of a successful drainage. Median survival was 202 days. The absence of a mass-type tumor or liver metastases, the absence of complications and successful drainage were identified as independent factors predicting survival at 12 months. Bilateral drainage with more than two stents was associated with a longer survival rate in patients with Bismuth III-IV tumors (271 versus 90 days) (p<0.050).


CONCLUSIONS
In Klatskin tumors, resolution of jaundice through an optimal stenting results in a better survival rate. Additional independent predictive factors are the absence of a mass-type tumor, liver metastases and post-drainage complications.
Arvanitakis
Marianna
M
Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium. maarvani@ulb.ac.be
Van Laethem
Jean-Luc
JL
Pouzere
Sylvain
S
Le Moine
Olivier
O
Deviere
Jacques
J
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality* / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate