Treatment and late survival of Altemeyer-Klatskin tumours

Aim of the study: Treatment options and late results of Altemeyer-Klatskin tumour of 348 patients admitted between 1999 – 2012 at the 1st Department of Surgery, Semmelweis University, were retrospectively investigated.

Methods/results: Out of 348 patients 162 underwent surgical resection. Postoperative mortality rate was 9.8 percent. Median survival rate of this group resulted in 35.3 months. In 186 cases tumor removal was impossible. Hospital mortality of this group was 18.2 percent. Median survival rate was 6.5 months. Preinterventional ERCP or ERCP+stent implantation in a referring institution has been attempted in 62.5% of all cases with lethal outcome. In nonresectable cases treatment involved intraoperative stenting, laparotomy only, laparotomy followed by PTD, or PTD only. Late survival was less favorable in intraoperative stenting group. (5.7 – 6.45 – 8.1 – 8.0 months)

Conclusions: Resectability rate of Altemeyer-Klatskin tumour is poor in Hungary. This is to be due to inadequate preoperative management of patient, with special respect to ERCP, which is obligatory causing severe cholangitis or intrahepatic abscess formation. Patients with mechanical jaundice require urgent US or MRCP, while ERCP or attempt of retrograde stenting should strictly be abandoned if hilar biliary occlusion were found. Patients need to be referred into a specialized surgical unit as soon as possible.