Klatskin tumor-palliative therapy: the jury is still out or may be not yet in...

摘要

Klatskin tumor, the perihilar cholangiocarcinoma that involves the biliary confluence, accounts for 6096 to 80% of bile-duct carcinomas seen in tertiary-referral centers1 and mostly is seen an advanced incurable stage amenable only to palliative therapy. Patients with advanced Klatskin tumor and cholangitis often have segmental intrahepatic biliary involvement, and complete biliary drainage may be impossible, in spite of using multiple stents to drain obstructed liver segments. In the absence of cholangitis, the dominant liver segment could be drained with a single stent.2'3 Both endoscopic and transhepatic biliary drainage, and, in some cases, rendezvous or a combined approach; has been proven effective and safe when using plastic or self-expandable metal stents (SEMS) to achieve biliary drainage. Successful bilateral stenting with more than 2 stents has been associated with longer survival in patients with unre-sectable hilar disease, but adequate drainage has been achieved in 65% to 78% of cases.4'5Initial complications have occurred in 11% of patients after ERCP and in 33% after percutaneous cholangiography (PTC), with a 5% 30-day mortality. It is interesting to note that, of the 5 patients who required PTC after an ERCP, 3 died within 30 days.5#