Actual Long-term Outcome of Klatskin's Tumor after Surgical Resection

ABSTRACT

PURPOSE: To analyze the actual long-term outcomes of Klatskin's tumors after surgical resection and identify the factors affecting the long-term survival. METHODS: We reviewed the medical records of 145 Klatskin's tumor cases, who underwent an operation between 1991 and 1999, and analyzed the actual outcomes and prognostic factors. The mean age of the subjects was 55, with a male to female ratio of 2.8 1. Seventy-six patients underwent resection with curative intent (resection rate 52.4%), including hilar resection (n=23), extended right hepatectomy (n=25), extended left hepatectomy (n=26) and hepatopancreatoduodenectomy (n=4). The operative mortality was 2.6%. The resection margin involvement rate was 21%. We also compared the clinicopathological characteristics between the long- term and short-term survivors. RESULTS: Twenty-one patients survived more than 5 years, with an actual 5-year survival rate of 28%. Among the survivors, 4 had a recurrent disease at 5 years and 3 developed a recurrence after 5 years. Some patients with well-known poor prognostic factors, such as lymph node metastasis and resection margin involvement, survived longer than 5 years. Lymph node metastasis was identified as a significant prognostic factor in a multivariate analysis. The long-term survivors had favorable T and N stages compared with the short-term survivors. CONCLUSION: The actual 5-year survival rate was 28%. Lymph node metastasis was found to be a significant prognostic factor. Long-term follow up is mandatory, as recurrences occurred later than 5 years after surgery. Aggressive surgical resection should be attempted to gain a chance for survival, even in patients with poor prognostic factors.