Klatskin tumours.

Abstract

Klatskin tumours are cholangiocarcinomas localized in the bifurcation of the common hepatic bile duct in the liver hilum. The tumor is rare. The recent increase in incidence is probably due to more accurate diagnostic procedures. The tumours constitute approximately 30 percent of the extrahepatic cholangiocarcinomas. The symptoms are progressive obstructive jaundice, weight loss and pain. In the early stage of the disease the diagnosis is difficult, as is preoperative histological verification. Ultrasonography reveals dilated intrahepatic bile ducts and a normal common duct. Sometimes the tumour in the liver hilum can be seen and fine-needle biopsy obtained. In nearly all cases transhepatic cholangiography can verify the diagnosis. Evaluation of resectability includes hepatic arteriography and portography. The tumour is very rarely resectable when vessel involvement is apparent. Resection of the tumour provides the only chance of cure, but only 25 per cent of the tumours are resectable and only half of these can be resected completely. Resection of the quadrate liver lobe facilitates dissection, and hemihepatectomy is often necessary for a curative resection. Surgical bypass and intubation may palliate jaundice, but a similar palliation may be obtained by non-operative biliary drainage by endoprostheses. The median survival for resected patients is approximately 1 1/2 year. Median survival for patients with unresectable tumours is less than 6 months and insignificantly prolonged by palliative procedures. Cholangiocarcinoma localized at and obstructing the bifurcation of the common hepatic bile duct (Fig. 1) has obtained the name Klatskin tumour from Gerald Klatskin, who in 1965 described 15 cases and found some characteristics for this type of cholangiocarcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)