PRIMITIVE HEPATIC HILUM NEOPLASM

One hundred ten cases of primitive hepatic hilum neoplasms (Klatskin t umor) observed from January 1970 to June 1992 are reviewed and the var iations occurring in the diagnostic back-up and treatment policy are c onsidered. The importance of careful preoperative staging is stressed. Preoperative tests should be limited to investigations supplying most informations about endo- and esobiliary diffusion of the tumoral mass (ultrasound, direct cholangiography, portography). This paper demonst rates that a surgical approach with both palliative or resective aims is suitable for all patients with no local or general contraindication s. Other cases are treated with percutaneous or endoscopic biliary ste nting. The authors conclude by pointing out that tumoral resection wit h biliodigestive anastomosis is in any case the treatment of choice in these patients as it gives a better quality of life (improved ''comfo rt index'').