Selection of the resection volume of the liver in patients with Klatskin tumor

• Main Authors: D. A. Granov, V. N. Polysalov, I. V. Timergalin
• Format: Article
• Language: Russian
• Published: Pavlov First Saint Petersburg State Medical University 2018-10-01
• Series: Вестник хирургии имени И.И. Грекова
• Subjects: ductal cholangiocarcinoma; klatskin tumor; hemihepatectomy; cholangioeynostomy; bile duct drainage; preoperative diagnosis; morphological study
• Online Access: https://www.vestnik-grekova.ru/jour/article/view/1050

The objective of the study was to determine the possibilities of surgical treatment and to evaluate the criteria for selecting the resection volume of the liver in patients with Klatskin tumor.Material and methods. From 2005 to 2018, 36 patients with Klatskin tumor aged from 30 to 74 years were operated in the Department of surgery of «Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov». Radical surgical interventions (R0) were performed in 28 (77.7 %) patients. 7 (19.5 %) patients underwent palliative surgery.Results. Selection of the resection volume of the liver and bile duct was carried out on the basis of assessment of the functional state, morphological changes in the liver and results of urgent intraoperative histological examination. As a radical intervention for IIIa, IIIb and IV types of Klatskin tumor (93.1 % of patients), extensive liver resection (left-sided or right-sided hemihepatectomy) with biliary and, in the presence of invasion into the main vessels, with vascular reconstruction was performed.Сonclusion. Timely and adequate liver resection with biliary reconstruction is a radical surgical intervention for Klatskin tumors. Selection of the resection volume of the liver, especially for type IV tumors, is determined by the morphological changes and the reserve capacity of the liver. The status of the resection edge is crucial for the selection of subsequent treatment tactics. Combination of methods of regional chemoinfusion and intraductal photodynamic therapy is necessary after non-radical intervention.