Extent of Liver Resection for Hilar Cholangiocarcinoma (Klatskin Tumor): How Much Is Enough?

Background: Hilar resection in combination with extended liver resections has resulted in a higher rate of R0 resections and increased survival in patients with hilar cholangiocarcinoma (HCCA). This aggressive surgical approach is, however, associated with high rates of operative morbidity and mortality, largely due to postresectional liver failure. We previously reported a series after resection of HCCA in which R0 resection rate was 59% with a mortality rate of 10%. In this study, we assessed mortality of extended liver resections after optimizing liver functional reserve and application of parenchyma-sparing techniques. Methods: From 2008 until June 2010, 41 consecutive patients underwent resection on the suspicion of HCCA. Preoperative workup included staging laparoscopy, preoperative biliary drainage, assessment of volume/function of future remnant liver and radiation therapy to prevent seeding metastases. Modified right and left extended hemihepatectomies were performed preserving parts of segments 4 and 8, respectively, while pursuing complete excision of the tumor. Outcomes of resection were evaluated. Results: The majority of resections (78%) were performed for Bismuth type III–IV tumors. Preoperative biliPublished online: April 29, 2011 Thomas M. van Gulik, MD Department of Surgery, Academic Medical Center Meibergdreef 9 NL–1105 AZ Amsterdam (The Netherlands) Tel. +31 20 566 5570, E-Mail t.m.vangulik @ amc.uva.nl © 2011 S. Karger AG, Basel 0253–4886/11/0282–0141$38.00/0 Accessible online at: www.karger.com/dsu D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 8/ 20 17 7 :0 8: 21 P M