title: [Major hepatectomies are safe in patients with cholangiocarcinoma and jaundice].
abstract: BACKGROUND
  Surgical resection is the only possibility of long term survival in patients with Klatskin tumours. However, surgical resection is a challenging problem and hepatic resection is often necessary.
  
  
  OBJECTIVE
  The aim of our study was to assess the need for biliary drainage, resection rate and outcome of hilar cholangiocarcinoma in a single tertiary referral centre.
  
  
  METHODS
  From 2005 to 2008, 26 patients with Klatskin tumours were identified and assessed prospectively with multidetector CT and MR cholangiography in special cases. Seven patients (27%) were deemed to be unresectable in pre-operative staging. A total of 19 surgical procedures were performed, 8 left hepatectomies, 5 right hepatectomies and 6 resections exclusively of the biliary tree.
  
  
  RESULTS
  Resection rate was 73%, transfusion rate 53% and preoperative biliary drainage was performed only in 7 cases (37%). Major complications occurred in 11 (58%), including two post-operative deaths (10%). There were no differences in the epidemiological data, when we separately analysed the outcomes of the 9 patients with bilirubin<15 mg/dL and the 10 patients with bilirubin>15 mg/dL. Biliary drainage was required in 6 (67%) patients in the group with low bilirubin levels vs. 1(10%) in the other group (P=0.02). The mean bilirubin level in the jaundiced group was 22.1+/-3.9 vs. 4.7+/-4.3 (P<0.001) in the other group. There were no differences in the postoperative outcome between both groups.
  
  
  CONCLUSIONS
  Resection and survival rates have increased recently but still carries the risk of significant morbidity and mortality. Major hepatectomies in selected patients without percutaneous biliary drainage are safe.
authors: Servicio de Cirugía, Hospital de Girona Dr Josep Trueta, Girona, Spain. info@jfigueras.net
authors: Joan
authors: J
authors: Figueras
authors: Antoni
authors: A
authors: Codina-Barreras
authors: Santiago
authors: S
authors: López-Ben
authors: Jordi
authors: J
authors: Soriano
authors: Berta
authors: B
authors: Pardina
authors: Laia
authors: L
authors: Falgueras
authors: Ernesto
authors: E
authors: Castro
authors: Silvia
authors: S
authors: Torres-Bahi
authors: Rosa
authors: R
authors: Ortiz
authors: Esther
authors: E
authors: Diaz
authors: Albert
authors: A
authors: Maroto
authors: Eugeni
authors: E
authors: Canals
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006500:Hepatic Duct, Common; D006801:Humans; D007565:Jaundice / Q000209:etiology; D018285:Klatskin Tumor / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies