Surgical treatment of hilar cholangiocarcinoma: from the era of Gerald Klatskin to the new era of the combined resection technologies

Summary. Cholangiocarcinoma (CC) is a primary hepatic tumor, arising from bile ducts epithelium. It is the second most common primary hepatic malignancy in the world. Specific localization and tumor growth explain low grade of resectability and comple­xity of eradicative surgical treatment. Purpose is to present features of pathologic anatomy and surgical tactic in CC treatment, report our own experience of eradicative surgical treatment in patients with Klatskin tumor. 7 eradicative surgical treatment in patients with Klatskin tumor were performed from 2011 till 2013 in HPB Surgery Department, Institute of General and Urgent Surgery, Kharkiv. Resectability was 58%. Extensive hepatic resections (4 segments and more) and mandatory combination with total caudal lobectomy were performed for all patients. Mortality was 14,2%. Index of furthest actuarial survival was: 1-year — 85,8%, 3-year — 42, 8%. Aggressive surgical tactic in CC treatment, including extensive hepatic resections with total caudal lobectomy, common bile duct removing, lymphodissection and, if necessary, resection of main hepatic vessels in portahepatis, provide the best results of treatment. Nevertheless, such kind of surgical interventions should be done only in specialized hepatobilliary departments with multimodality approach (hepatobiliary surgeons, transplantologists, oncologists, chemoterapists,radiologists).