Orthotopic liver transplantation for patients with Klatskin tumor

摘要

BACKGROUND; It is not certain whether Klatskin tumor should be a routine indication for orthotopic liver trans- plantation (OLT). This study was to summarize the indi- cation and value of orthotopic liver transplantation for pa- tients with Klatskin tumor. METHODS; Forty patients with Klatskin tumors including 5 patients who had had liver transplantation ( LTx) and 35 patients who had not undergone LTx ( WLTx) from Janu- ary 1992 to December 2003 were analyzed retrospectively. Their TNM stages were comparable in both groups. In the LTx group, 4 patients had Klatskin tumor including recur- rent tumor after resection ( 1 ), and 1 cancerization from Carolis disease. Biliary duct anastomosis was made by Roux-en-Y choledochojejunostomy in 2, and end-to-end choledochocholedochostomy (C-C) in 3. RESULTS: In the LTx group, the total resection rate and radical resection rate were both 100%. Four patients have been surviving for 48, 38, 21 and 5 months, respectively, except one died from bile leakage at day 40 after transplan- tation. All 4 survivors enjoyed good life without tumors at local and distant sites, even though 2 of these patients de- veloped biliary stricture, which was soon resolved by radio- logical intervention. The 1-,3-year survival rates were both 80% in this group. The total resection rate and radical re- section rate in the WLTx group were 63.0% ( 17/27) and 40.7% (11/27 ) and, the 1-, 3-, 5-year survival rates were 32.2%, 8.0%, 0%, respectively. There were significant differences between the two groups in radical resection rates and survival rates( P =0.016).CONCLUSIONS: OLT is a good choice for patients with unresectable Klatskin tumor by routine modalities. The prognosis of patients undergoing OLT is encouraging.