title: Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor).
abstract: BACKGROUND
  Treatment of hilar cholangiocarcinoma (Klatskin tumors) has changed in many aspects. A more extensive surgical approach, as proposed by Japanese surgeons, has been applied in our center over the last 5 years; it combines hilar resection with partial hepatectomy for most tumors. The aim of this study was to assess the outcome of a 15-year evolution in the surgical treatment of Klatskin tumors.
  
  
  METHODS
  A total of 99 consecutive patients underwent resection for hilar cholangiocarcinoma in three 5-year time periods: periods 1 (1988-1993; n=45), 2 (1993-1998; n=25), and 3 (1998-2003; n=29). Outcome was evaluated by assessment of completeness of resection, postoperative morbidity and mortality, and survival.
  
  
  RESULTS
  The proportion of margin negative resections increased significantly from 13% in period 1 to 59% in period 3 (P<.05). Two-year survival increased significantly from 33%+/-7% and 39%+/-10% in periods 1 and 2 to 60%+/-11% in period 3 (P<.05). Postoperative morbidity and mortality were considerable but did not increase with this changed surgical strategy (68% and 10%, respectively, in period 3). Lymph node metastasis was, next to period of resection, also associated with survival in univariate analysis.
  
  
  CONCLUSIONS
  Mainly in the last 5-year period (1998-2003), when the Japanese surgical approach was followed, more hilar resections were combined with partial liver resections that included segments 1 and 4, thus leading to more R0 resections. This, together with a decrease in lymph node metastases, resulted in improved survival without significantly affecting postoperative morbidity or mortality.
authors.affiliation: Department of Surgery, Academic Medical Center, P.O. Box 22700, 1100, DE, Amsterdam, The Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Dinant
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
authors.forename: E A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome