title: Surgical and combined treatment of patients with Klatzkin's tumor.
abstract: Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.
authors.forename: Iu I
authors.initials: IuI
authors.lastname: Patiutko
authors.forename: A N
authors.initials: AN
authors.lastname: Poliakov
authors.forename: A G
authors.initials: AG
authors.lastname: Kotel'nikov
authors.forename: I V
authors.initials: IV
authors.lastname: Sagaĭdak
authors.forename: A D
authors.initials: AD
authors.lastname: Gakhramanov
authors.forename: E A
authors.initials: EA
authors.lastname: Moroz
authors.forename: I
authors.initials: I
authors.lastname: Chaĭ
mesh_terms: D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009031:Moscow / Q000453:epidemiology; D009367:Neoplasm Staging; D061646:Operative Time; D010778:Photochemotherapy / Q000379:methods; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome