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Original Article
 
Operated Klatskin tumors: A series of 22 patients in a single center in Lebanon
Carine Korkmaz1, Sami Choucair2, Jihad Irani3, Elias Saikaly4, Ziad El Rassi5
1MD (General Surgery Chief Resident), The Saint George Hospital University Medical Center, Beirut, Lebanon, The Faculty of Medicine and Medical Sciences of Blalamand Univeristy, Beirut, Lebanon.
2MD (Medical Student), the Saint George Hospital University Medical Center, Beirut, Lebanon, the Faculty of Medicine and Medical Sciences of Blalamand Univeristy, Beiut, Lebanon.
3MD (Assistant Dean for Medical Education and Associate Professor of Family Medicine), The Saint George Hospital University Medical Center, Beirut, Lebanon, The Faculty of Medicine and Medical Sciences of Blalamand Univeristy, Beirut, Lebanon.
4MD (General Surgery Resident), the Saint George Hospital University Medical Center, Beirut, Lebanon, the Faculty of Medicine and Medical Sciences of Blalamand Univeristy, Beirut, Lebanon.
5MD (General Surgeon, Chief of department), The Saint George Hospital University Medical Center, Beirut, Lebanon, The Faculty of Medicine and Medical Sciences of Blalamand Univeristy, Beirut, Lebanon.

Article ID: 100052IJHPDCK2016
doi:10.5348/ijhpd-2016-52-OA-8

Address correspondence to:
Carine Korkmaz
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86000, Poitiers
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How to cite this article
Korkmaz C, Choucair S, Irani J, Saikaly E, El Rassi Z. Operated Klatskin tumors: A series of 22 patients in a single center in Lebanon. Int J Hepatobiliary Pancreat Dis 2016;6:34–42.


Abstract
Aims: Klatskin tumors are the most common type of cholangiocarcinomas and they arise at the confluence of the bile ducts. The Bismuth classification divides them into four categories: I, II, IIIa/IIIb and IV. We retrospectively studied a series of 22 patients operated for Klatskin tumors and investigated the relation between clinicopathological features (size, extent of resection, bilirubin and prothrombine time (PT) levels, etc.), and outcome factors such as morbidity/mortality and recurrence.
Methods: The hospital records were searched from 2001–2013 for operated Klatskin tumors. Five patients had types I/II and underwent resection of the bile ducts with regional lymphadenectomy, the remaining 17 patients had the same in addition to a right hepatectomy for type IIIa (8 patients), and a left hepatectomy for type IIIb (9 patients).
Results: R0 resection rate was 91%. Bilirubin levels increased recurrence (p = 0.028). Decreased PT activity affected mortality (p = 0.019), and creatinine levels were found to increase mortality (p = 0.027) and diminish 1 and 3 year survival (p = 0.011, p = 0.027).
Conclusion: R0 resection remains the most important factor to guide extent of surgery and to affect outcome. Bilirubin, PT and creatinine are valuable prognostic tools and "optimizing liver function" prior to surgery should be attempted. Further studies with a bigger sample are needed to better elucidate the effect of clinicopathological parameters on outcome.

Keywords: Hilar cholangiocarcinoma, Hepatectomy, Klatskin, Regional lymphadenectomy


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Author Contributions:
Carine Korkmaz – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sami Choucair – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jihad Irani – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Elias Saikaly – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ziad El Rassi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Carine Korkmaz et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.