Outcome of surgical resection in Klatskin tumors

Table 1 Staging of perihilar cholangiocarcinoma (Green FL 2002)

Tumor, nodes and metastases definitions
Primary tumor
Tis Carcinoma in situ
T1 Tumor confined to the bile duct histologically
T2 Tumor invades beyond the wall of the bile duct
T3 Tumor invades the liver, gallbladder, pancreas, and/or ipsilateral branches of the portal vein or hepatic artery
T4 Tumor invades any of the following: main portal vein or its branches bilaterally, common hepatic artery, or other adjacent structures, such as the colon, stomach, duodenum, or abdominal wall.
Regional lymph nodes
N0 No regional lymph node metastasis
N1 Regional lymph node metastases
Metastasis
M0 No distant metastasis
M1 Distant metastasis
Stage grouping
Stage 0 Tis, N0, M0
Stage IA T1, N0, M0
Stage IB T2, N0, M0
Stage IIA T3, N0, M0
Stage IIB T1, N1, M0 T2, N1, M0 T3, N1, M0
Stage III T4, any N, M0
Stage IV Any T, any N, M1

Table 2 Memorial Sloan Kettering Cancer Centre stage

Stage	Hilar involvement	Portal vein	Lobar atrophy
T1	Biliary confluence ± 1/2 unilateral extension to second-order biliary radicles	No	No
T2	Biliary confluence ± unilateral extension to second-order biliary radicles	+ Ipsilateral	+ Ipsilateral
	Biliary confluence + bilateral extension to second-order biliary radicles	Yes/No	Yes/No
	Biliary confluence + unilateral extension to second-order biliary radicles	+ Contralateral	Yes/No
T3	Biliary confluence + unilateral extension to second-order biliary radicles with contralateral hepatic lobar atrophy;	Yes/No	+ Contralateral
	Biliary confluence + unilateral/bilateral	Bilateral	Yes/No

Table 3 Prognostic factors and 5-year survival rate

Hilar cholangiocarcinoma	No. of patients	Prognostic factors	Operative mortality(%)	5-yr SV (%)
Jarnagin et al[14]	80	Margin, hepatectomy, differentiation	10	27
Seyama et al[20]	58	Lymph nodes	0	40
Dinant et al[27]	99	Margin, resection period, lymph nodes	15	27
DeOliveira et al[43]	281	Margin, lymph nodes	5	10
Rea et al[45]	46	Lymph nodes, tumor grade, bilirubin	9	26
Silva et al[46]	45	Tumor stage, margin	9	11
Witzigmann et al[47]	60	Residual tumor status, grading	8	22
Baton et al[48]	59	Chemotherapy, margin, lymph nodes	5	20
Wahab et al[55]	243	Margin, S1 resection, lymph nodes, grading	7	16
de Jong et al[90]	305	Lymph nodes, margin	5	20

SV: Survival rate.

Table 4 Morbidity and mortality rate and R0 resections

Ref.	Resections	R0(%)	Morbidity	Mortality	5-yr Survival rate
Burke et al[3]	30	83	NA	6	45
Nakeeb et al[4]	109	26	47	4	11
Jarnagin et al[14]	80	78	64	10	26
Nimura et al[15]	55	84	41	6	41
Jarnagin et al[17]	106	77	62	8	NA
Seyama et al[20]	87	64	43	0	40
Kosuge et al[23]	65	52	37	9	33
Neuhaus et al[24]	80	61	55	8	22
Launois et al[25]	131	NA	NA	19	NA
Kondo et al[26]	40	95	48	0	NA
Dinant et al[27]	99	31	66	15	27
Gerhards et al[29]	112	14	65	18	NA
Hemming et al[32]	53	80	40	9	35
IJitsma et al[33]	42	65	76	12	19
Kawarada et al[34]	65	64	28	2.3	26
Klempnauer et al[35]	151	77	NA	10	28
Miyazaki et al[37]	76	71	33	13	26
Nimura et al[38]	142	61	49	9	26
Su et al[39]	49	49	47	10	15
Todoroki et al[41]	101	14	14	4	28
DeOliveira et al[43]	281	62	60	5	30
Nagino et al[44]	574	76.5	43.1	4.7	32.5
Rea et al[45]	46	80	52	9	26
Nuzzo et al[74]	440	77.3	47.5	8.6	25.5
Ito et al[85]	38	63	32	0	33
Kawasaki et al	79	68	14	1.3	22

NA: Not available.