Abstract:

Background and Aims: Klatskin tumor is an epithelial biliary duct tumor arising from main hepatic duct or left-right intrahepatic duct and is proximal to the cystic duct opening. The diagnosis of the disease is late and life expectancy is low. Palliative procedures such as endoscopic or percutaneous biliary drainage for the drainage of even are used for patients contraindicated for surgery. In this study, we aimed to evaluate the efficiency of procedures and survival in the inoperable Klatskin tumor patients given palliative treatment with endoscopic stent and/or percutaneous drainage. Materials and Methods: This study was done retrospectively in the Gastroenterology Department of İzmir Atatürk Training and Research Hospital between January 2008 and September 2009. Thirty-four inoperable hilar cholangiocarcinoma patients were included in the study. The classification of the disease was done according to Bismuth classification. Results: Nineteen females and 15 males were included in the study. The average age was 71.8±8.9 years. The drainage was inadequate in 7 (21%) patients. Percutaneous drainage catheter was placed in 2 (6%) of the patients in whom drainage failed. The decrease in bilirubin levels was not sufficient in percutaneous drainage-applied patients. Mean survival was 145±138 days in patients with adequate drainage with endoscopic stenting versus 13.2±7 days in 5 patients with insufficient drainage and who did not allow percutaneous drainage. Mean survival in the 2 percutaneous drainage-applied patients due to insufficient drainage after stenting was 22±11.3 days. Mean survival was 164.2±19.3, 86±125.6, 134.7±130.8, and 89.3±132.5 days in Bismuth-classified 1, 2, 3, and 4 patients, respectively. There was no statistical difference between groups according to Bismuth classification (p=0.317). Conclusions: In this study, we determined that the success rate of endoscopic treatment was high and the localization of tumor was not effective on average survival. However, we believe that stenting can contribute to average survival in a palliative manner, and a minimum of two sessions of endoscopic retrograde cholangiopancreatography should be attempted to provide palliative drainage in patients.

Keywords: