Therapeutical concepts and results for Klatskin tumors.
BACKGROUND
Most hilar cholangiocarcinomas (Klatskin tumors) are diagnosed at an advanced stage. This article aims to review the literature of resection and palliative treatment in patients with hilar cholangiocarcinoma.


METHODS
All studies with evidence levels I and II and relevant trials with evidence level III from 1996 to 04/2007 were included.


RESULTS
The definition of resectability depends not only on tumor stage but also on operator experience. The best long-term results are achieved by hilar resection combined with extended liver resection. No clear clinical benefit has been demonstrated for neoadjuvant and adjuvant therapies. The role of liver transplantation requires redefinition in view of good long-term survival after neoadjuvant chemoradiation and the possibility of living-donor liver transplantation. Initial studies of a combination of biliary stenting and photodynamic therapy (PDT) for palliation have shown significantly prolonged survival times compared with stenting alone. There is no established standard palliative chemotherapy.


CONCLUSIONS
The prognosis of patients with Klatskin tumors has been significantly improved by extended resection procedures. The combination of stenting and PDT is a useful palliative approach.
Witzigmann
Helmut
H
Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Dresden-Friedrichstadt, Friedrichstrasse 41, Dresden, Germany. Helmut.Witzigmann@khdf.de
Wiedmann
Marcus
M
Wittekind
Christian
C
Mössner
Joachim
J
Hauss
Johann
J