title: Klatskin tumour: meticulous preoperative work-up and resection rate.
abstract: BACKGROUND
  Surgery represents the only potentially curative treatment of hilar cholangiocarcinoma (hilCC). It may be suggested that meticulous preoperative work-up in Asian countries leads to higher resection rates.
  
  
  METHODS
  One hundred and eighty-two patients treated in our department between 1998 and 2008 were included in an analysis based on our prospectively recorded database. Among them, 75 % had a percutaneous transhepatic cholangiography as part of their diagnostic work-up. A total of 160 patients underwent explorative surgery and 123 patients were resected (77 % of patients undergoing exploration, 68 % of all patients).
  
  
  RESULTS
  Ninety-one percent of the patients were diagnosed to have Bismuth III and IV tumours. En-bloc resection of the tumour and the adjacent liver including segment 1 was the standard procedure in 109 of these patients, while hilar resection was performed in 14 patients. Upon tumour resection, hospital mortality was 5.7 %. Five-year survival in patients without surgery or with mere exploration was 0 %, after resection it reached 26 %. Patients with R 1 resection experienced longer survival than patients without resection (p < 0.001). Right and left hemihepatectomies were performed with identical frequency resulting in identical survival. Lymph node involvement proved to be the only significant predictor of prognosis (p = 0.006).
  
  
  CONCLUSIONS
  Resection should be performed whenever possible since even after palliative resection survival is substantially increased compared to patients without resection. Meticulous preoperative work-up may contribute to a high resection rate in patients with hilCC by providing additional information allowing the surgeon to perform more aggressive approaches.
authors.affiliation: Departments of Transplantation and Hepatobiliopancreatic Surgery of the Johannes Gutenberg University of Mainz, Germany. otto@transplantation.klinik.unimainz.de
authors.forename: G
authors.initials: G
authors.lastname: Otto
authors.forename: M
authors.initials: M
authors.lastname: Hoppe-Lotichius
authors.forename: F
authors.initials: F
authors.lastname: Bittinger
authors.forename: M
authors.initials: M
authors.lastname: Schuchmann
authors.forename: C
authors.initials: C
authors.lastname: Düber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D002758:Cholangiography / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000401:mortality / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome