The treatment of Klatskin’s tumor requires a multidisciplinary approach, in which surgeons, gastroenterologists, radiologists, oncologists and radiotherapists collaborate. Our expert in General Surgery talks about it
Klatskin’s tumor is characterized by a discrete tumor mass in the liver. The removal of this tumor volume often requires biliary anastomosis, i.e. a connection between the biliary tract and the stomach, which is why the risk of complications frequently occurs during the postoperative phase (40-50%) .
Unfortunately, the prognosis is not always favorable for most patients diagnosed with cholangiocarcinoma. The disease occurs at an advanced stage already at the time of diagnosis and only 20-30% of patients can undergo surgery, considered the only way to treat this neoplasm. The survival rate for extrahepatic cholangiocarcinomas is around 15-20% with an estimate up to 5 years, since it can vary depending on the localization of the tumor. On the other hand, the percentage of metastatic tumors is about 1%.
Klatskin tumor: how is it treated?
The surgical resection of the biliary carrefour, that is the point where both bile ducts join, and the removal of the liver area where the pathology is present, represent today the only solution to treat this type of tumor.
Furthermore, it is also necessary to practice a locoregional lymphadenectomy, i.e. to remove the lymph nodes near the tumor site, even if these have not been affected by the disease.
If there are no conditions to proceed with the surgery, the patient will be given a chemotherapy and / or radiotherapy program to reduce the size of the tumor. We will then evaluate whether it will be possible to operate on the patient.
The Klatskin tumor patient is managed according to a structured protocol, which includes:
- Diagnostic laparoscopy , thanks to which it is possible to avoid surgical operations for those patients on whom, however, it is not possible to remove the pathology;
- Management of jaundice and evaluation of inserting biliary drainage through the skin to ensure an improvement in liver function, in view of future operations;
- Evaluation of the volume of residual liver in order to guarantee the patient vital functions during the post-surgery phase. The liver is an organ that has the ability to regenerate following surgery, but it still takes a few months. In order to avoid risks of liver failure it is necessary to maintain about 40% of the liver. If this condition does not exist, it is necessary to evaluate new procedures to increase the amount of residual liver.
Prognosis and follow up
Following the intervention, it will be necessary to subject the patient to chemotherapy and radiotherapy (after evaluating the characteristics of the disease and the subject) and to continuous periodic visits that can occur up to 5 years after the intervention. This phase is called follow up and is used to exclude the risk of disease recurrence.