Proximal bile duct cancer : High resectability rate and 5-year survival
To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years. Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative...
Gespeichert in:
| Veröffentlicht in: | Annals of surgery 1999-08, Vol.230 (2), p.266-275 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 275 |
|---|---|
| container_issue | 2 |
| container_start_page | 266 |
| container_title | Annals of surgery |
| container_volume | 230 |
| creator | LAUNOIS, B TERBLANCHE, J LAKEHAL, M CATHELINE, J. M BARDAXOGLOU, E LANDEN, S CAMPION, J. P SUTHERLAND, F MEUNIER, B |
| description | To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years.
Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative procedures. The authors adopted a radical surgical approach aimed at definitive cure in 1974. Recent reports suggest that resection improves outcome.
The records of 40 of 94 patients (23 men, 17 women, age range 34-81 years) diagnosed with proximal bile duct carcinoma who underwent resection between 1968 and 1993 were reviewed. According to the Bismuth classification, there were five type I, four type II, 25 type III, and six type IV lesions; 11 patients underwent tumor resection alone, and 25 patients had combined tumor and liver resection (seven of these also underwent an associated regional vascular resection). In 3 patients, venous allografts were harvested from cadaveric donors and used to reconstruct the portal vein. Four patients underwent liver transplantation; in two, organ cluster-type resections including the liver with porta hepatitis and pancreas were performed.
The resectability rate in the more recent period of the study was 49.4%. Most type I, three (of four) type II, T in situ, T1a, T1b, and all stage 0 tumors were resected without hepatectomy. In the other subgroups of tumors, the main surgical procedure was hepatectomy. Thirty-day mortality was 12.5%. After tumor resection alone, survival at 1, 3, and 5 years was 81.8%, 45.5%, and 27.3%, respectively. After tumor resection and hepatectomy without vascular resection, 1-, 3-, and 5-year survival was 66.7%, 16.7%, and 6%, respectively. With vascular resection, survival rates were similar: 64%, 20%, and 4%, respectively.
The type of surgery required to achieve cure is closely related to tumor location, TNM classification, and staging. Increasing resectability through the use of hepatectomy improves survival and offers a chance of cure in patients with more advanced disease. |
| doi_str_mv | 10.1097/00000658-199908000-00018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1420870</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69962689</sourcerecordid><originalsourceid>FETCH-LOGICAL-c511t-935472fc002b3876166da1c627e74f511aa77f6523745c3aaa732146a67fe6943</originalsourceid><addsrcrecordid>eNpVkU1LAzEQhoMoWqt_QXIQb6v5zsaDIKJVEPSg5zBNs21ku1uT3WL_vdFWrYEQZuaZN8m8CGFKzikx-oJ8LSXLghpjSJmDIm9a7qABlSynqSC7aJBzvBCGswN0mNJbJkRJ9D46oERIogUboNFzbD_CHGo8DrXHk9512EHjfMSX-D5MZzj65F0HuRy6FY7QeQzNBMti5SHi1MdlWEJ9hPYqqJM_3pxD9Hp3-3JzXzw-jR5urh8LJyntCsOl0KxyhLAxL7WiSk2AOsW016LKCIDWlZKMayEdhxxyRoUCpSuvjOBDdLXWXfTjuZ8433QRaruI-Q9xZVsI9n-lCTM7bZeWCkZKTbLA2UYgtu-9T52dh-R8XUPj2z5ZZYxiqjQZLNegi21K0Ve_l1Biv1ywPy7YXxfstwu59WT7kVuN67Fn4HQDQHJQVzFPPKQ_zmRVJvknprWOdA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69962689</pqid></control><display><type>article</type><title>Proximal bile duct cancer : High resectability rate and 5-year survival</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Complete</source><source>PubMed Central</source><creator>LAUNOIS, B ; TERBLANCHE, J ; LAKEHAL, M ; CATHELINE, J. M ; BARDAXOGLOU, E ; LANDEN, S ; CAMPION, J. P ; SUTHERLAND, F ; MEUNIER, B</creator><creatorcontrib>LAUNOIS, B ; TERBLANCHE, J ; LAKEHAL, M ; CATHELINE, J. M ; BARDAXOGLOU, E ; LANDEN, S ; CAMPION, J. P ; SUTHERLAND, F ; MEUNIER, B</creatorcontrib><description>To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years.
Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative procedures. The authors adopted a radical surgical approach aimed at definitive cure in 1974. Recent reports suggest that resection improves outcome.
The records of 40 of 94 patients (23 men, 17 women, age range 34-81 years) diagnosed with proximal bile duct carcinoma who underwent resection between 1968 and 1993 were reviewed. According to the Bismuth classification, there were five type I, four type II, 25 type III, and six type IV lesions; 11 patients underwent tumor resection alone, and 25 patients had combined tumor and liver resection (seven of these also underwent an associated regional vascular resection). In 3 patients, venous allografts were harvested from cadaveric donors and used to reconstruct the portal vein. Four patients underwent liver transplantation; in two, organ cluster-type resections including the liver with porta hepatitis and pancreas were performed.
The resectability rate in the more recent period of the study was 49.4%. Most type I, three (of four) type II, T in situ, T1a, T1b, and all stage 0 tumors were resected without hepatectomy. In the other subgroups of tumors, the main surgical procedure was hepatectomy. Thirty-day mortality was 12.5%. After tumor resection alone, survival at 1, 3, and 5 years was 81.8%, 45.5%, and 27.3%, respectively. After tumor resection and hepatectomy without vascular resection, 1-, 3-, and 5-year survival was 66.7%, 16.7%, and 6%, respectively. With vascular resection, survival rates were similar: 64%, 20%, and 4%, respectively.
The type of surgery required to achieve cure is closely related to tumor location, TNM classification, and staging. Increasing resectability through the use of hepatectomy improves survival and offers a chance of cure in patients with more advanced disease.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/00000658-199908000-00018</identifier><identifier>PMID: 10450742</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms - mortality ; Bile Duct Neoplasms - pathology ; Bile Duct Neoplasms - surgery ; Biological and medical sciences ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatic Duct, Common ; Humans ; Klatskin Tumor - mortality ; Klatskin Tumor - pathology ; Klatskin Tumor - surgery ; Liver, biliary tract, pancreas, portal circulation, spleen ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Neoplasm Staging ; Original ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Surgical Procedures, Operative - methods ; Survival Rate ; Time Factors ; Tumors</subject><ispartof>Annals of surgery, 1999-08, Vol.230 (2), p.266-275</ispartof><rights>1999 INIST-CNRS</rights><rights>1999 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-935472fc002b3876166da1c627e74f511aa77f6523745c3aaa732146a67fe6943</citedby><cites>FETCH-LOGICAL-c511t-935472fc002b3876166da1c627e74f511aa77f6523745c3aaa732146a67fe6943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420870/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420870/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1965825$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10450742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LAUNOIS, B</creatorcontrib><creatorcontrib>TERBLANCHE, J</creatorcontrib><creatorcontrib>LAKEHAL, M</creatorcontrib><creatorcontrib>CATHELINE, J. M</creatorcontrib><creatorcontrib>BARDAXOGLOU, E</creatorcontrib><creatorcontrib>LANDEN, S</creatorcontrib><creatorcontrib>CAMPION, J. P</creatorcontrib><creatorcontrib>SUTHERLAND, F</creatorcontrib><creatorcontrib>MEUNIER, B</creatorcontrib><title>Proximal bile duct cancer : High resectability rate and 5-year survival</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years.
Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative procedures. The authors adopted a radical surgical approach aimed at definitive cure in 1974. Recent reports suggest that resection improves outcome.
The records of 40 of 94 patients (23 men, 17 women, age range 34-81 years) diagnosed with proximal bile duct carcinoma who underwent resection between 1968 and 1993 were reviewed. According to the Bismuth classification, there were five type I, four type II, 25 type III, and six type IV lesions; 11 patients underwent tumor resection alone, and 25 patients had combined tumor and liver resection (seven of these also underwent an associated regional vascular resection). In 3 patients, venous allografts were harvested from cadaveric donors and used to reconstruct the portal vein. Four patients underwent liver transplantation; in two, organ cluster-type resections including the liver with porta hepatitis and pancreas were performed.
The resectability rate in the more recent period of the study was 49.4%. Most type I, three (of four) type II, T in situ, T1a, T1b, and all stage 0 tumors were resected without hepatectomy. In the other subgroups of tumors, the main surgical procedure was hepatectomy. Thirty-day mortality was 12.5%. After tumor resection alone, survival at 1, 3, and 5 years was 81.8%, 45.5%, and 27.3%, respectively. After tumor resection and hepatectomy without vascular resection, 1-, 3-, and 5-year survival was 66.7%, 16.7%, and 6%, respectively. With vascular resection, survival rates were similar: 64%, 20%, and 4%, respectively.
The type of surgery required to achieve cure is closely related to tumor location, TNM classification, and staging. Increasing resectability through the use of hepatectomy improves survival and offers a chance of cure in patients with more advanced disease.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bile Duct Neoplasms - mortality</subject><subject>Bile Duct Neoplasms - pathology</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatic Duct, Common</subject><subject>Humans</subject><subject>Klatskin Tumor - mortality</subject><subject>Klatskin Tumor - pathology</subject><subject>Klatskin Tumor - surgery</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Original</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Surgical Procedures, Operative - methods</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Tumors</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1LAzEQhoMoWqt_QXIQb6v5zsaDIKJVEPSg5zBNs21ku1uT3WL_vdFWrYEQZuaZN8m8CGFKzikx-oJ8LSXLghpjSJmDIm9a7qABlSynqSC7aJBzvBCGswN0mNJbJkRJ9D46oERIogUboNFzbD_CHGo8DrXHk9512EHjfMSX-D5MZzj65F0HuRy6FY7QeQzNBMti5SHi1MdlWEJ9hPYqqJM_3pxD9Hp3-3JzXzw-jR5urh8LJyntCsOl0KxyhLAxL7WiSk2AOsW016LKCIDWlZKMayEdhxxyRoUCpSuvjOBDdLXWXfTjuZ8433QRaruI-Q9xZVsI9n-lCTM7bZeWCkZKTbLA2UYgtu-9T52dh-R8XUPj2z5ZZYxiqjQZLNegi21K0Ve_l1Biv1ywPy7YXxfstwu59WT7kVuN67Fn4HQDQHJQVzFPPKQ_zmRVJvknprWOdA</recordid><startdate>19990801</startdate><enddate>19990801</enddate><creator>LAUNOIS, B</creator><creator>TERBLANCHE, J</creator><creator>LAKEHAL, M</creator><creator>CATHELINE, J. M</creator><creator>BARDAXOGLOU, E</creator><creator>LANDEN, S</creator><creator>CAMPION, J. P</creator><creator>SUTHERLAND, F</creator><creator>MEUNIER, B</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19990801</creationdate><title>Proximal bile duct cancer : High resectability rate and 5-year survival</title><author>LAUNOIS, B ; TERBLANCHE, J ; LAKEHAL, M ; CATHELINE, J. M ; BARDAXOGLOU, E ; LANDEN, S ; CAMPION, J. P ; SUTHERLAND, F ; MEUNIER, B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-935472fc002b3876166da1c627e74f511aa77f6523745c3aaa732146a67fe6943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bile Duct Neoplasms - mortality</topic><topic>Bile Duct Neoplasms - pathology</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatic Duct, Common</topic><topic>Humans</topic><topic>Klatskin Tumor - mortality</topic><topic>Klatskin Tumor - pathology</topic><topic>Klatskin Tumor - surgery</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Original</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Surgical Procedures, Operative - methods</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LAUNOIS, B</creatorcontrib><creatorcontrib>TERBLANCHE, J</creatorcontrib><creatorcontrib>LAKEHAL, M</creatorcontrib><creatorcontrib>CATHELINE, J. M</creatorcontrib><creatorcontrib>BARDAXOGLOU, E</creatorcontrib><creatorcontrib>LANDEN, S</creatorcontrib><creatorcontrib>CAMPION, J. P</creatorcontrib><creatorcontrib>SUTHERLAND, F</creatorcontrib><creatorcontrib>MEUNIER, B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LAUNOIS, B</au><au>TERBLANCHE, J</au><au>LAKEHAL, M</au><au>CATHELINE, J. M</au><au>BARDAXOGLOU, E</au><au>LANDEN, S</au><au>CAMPION, J. P</au><au>SUTHERLAND, F</au><au>MEUNIER, B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proximal bile duct cancer : High resectability rate and 5-year survival</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>1999-08-01</date><risdate>1999</risdate><volume>230</volume><issue>2</issue><spage>266</spage><epage>275</epage><pages>266-275</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>To review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years.
Until recently, resection of proximal bile duct carcinoma was uncommon, with most patients undergoing palliative procedures. The authors adopted a radical surgical approach aimed at definitive cure in 1974. Recent reports suggest that resection improves outcome.
The records of 40 of 94 patients (23 men, 17 women, age range 34-81 years) diagnosed with proximal bile duct carcinoma who underwent resection between 1968 and 1993 were reviewed. According to the Bismuth classification, there were five type I, four type II, 25 type III, and six type IV lesions; 11 patients underwent tumor resection alone, and 25 patients had combined tumor and liver resection (seven of these also underwent an associated regional vascular resection). In 3 patients, venous allografts were harvested from cadaveric donors and used to reconstruct the portal vein. Four patients underwent liver transplantation; in two, organ cluster-type resections including the liver with porta hepatitis and pancreas were performed.
The resectability rate in the more recent period of the study was 49.4%. Most type I, three (of four) type II, T in situ, T1a, T1b, and all stage 0 tumors were resected without hepatectomy. In the other subgroups of tumors, the main surgical procedure was hepatectomy. Thirty-day mortality was 12.5%. After tumor resection alone, survival at 1, 3, and 5 years was 81.8%, 45.5%, and 27.3%, respectively. After tumor resection and hepatectomy without vascular resection, 1-, 3-, and 5-year survival was 66.7%, 16.7%, and 6%, respectively. With vascular resection, survival rates were similar: 64%, 20%, and 4%, respectively.
The type of surgery required to achieve cure is closely related to tumor location, TNM classification, and staging. Increasing resectability through the use of hepatectomy improves survival and offers a chance of cure in patients with more advanced disease.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>10450742</pmid><doi>10.1097/00000658-199908000-00018</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-4932 |
| ispartof | Annals of surgery, 1999-08, Vol.230 (2), p.266-275 |
| issn | 0003-4932 1528-1140 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1420870 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; PubMed Central |
| subjects | Adult Aged Aged, 80 and over Bile Duct Neoplasms - mortality Bile Duct Neoplasms - pathology Bile Duct Neoplasms - surgery Biological and medical sciences Female Gastroenterology. Liver. Pancreas. Abdomen Hepatic Duct, Common Humans Klatskin Tumor - mortality Klatskin Tumor - pathology Klatskin Tumor - surgery Liver, biliary tract, pancreas, portal circulation, spleen Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Neoplasm Staging Original Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Surgical Procedures, Operative - methods Survival Rate Time Factors Tumors |
| title | Proximal bile duct cancer : High resectability rate and 5-year survival |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T07%3A31%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Proximal%20bile%20duct%20cancer%20:%20High%20resectability%20rate%20and%205-year%20survival&rft.jtitle=Annals%20of%20surgery&rft.au=LAUNOIS,%20B&rft.date=1999-08-01&rft.volume=230&rft.issue=2&rft.spage=266&rft.epage=275&rft.pages=266-275&rft.issn=0003-4932&rft.eissn=1528-1140&rft.coden=ANSUA5&rft_id=info:doi/10.1097/00000658-199908000-00018&rft_dat=%3Cproquest_pubme%3E69962689%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=69962689&rft_id=info:pmid/10450742&rfr_iscdi=true |