Proximal bile duct cholangiocarcinomas.

Aim: The aim of this retrospective study was to report a series of 12 patie nts with hilar cholangiocarcinoma treated by curative resection. Patients and methods: Between 1980 and 1998, curative resection was perform ed in 12 patients out of 33 patients with a Klatskin's tumor. Preoperative biliary drainage was performed in 6 cases. Resection was limited to the ext rahepatic bile duct in one case only. Resection was extended to the liver i n 11 cases including segmentectomy I (n = 9), left hepatectomy (n = 7), rig ht hepatectomy (n = 3) and segmentectomy IV (n = 1). Postoperative brachyth erapy was performed in 3 patients combined with conventional radiotherapy. Conventional radiotherapy irradiation was performed in 2 patients and was a ssociated with chemotherapy in 1 patient. Results: There was no postoperative mortality. Postoperative follow-up was uneventful in 5 patients. Actuarial survival rate at 1, 2, 3, and 5 years w as 81, 57, 28 and 28%, respectively. Prolonged survivals (88 and 114 months ) were observed. Conclusion: Hilar cholangiocarcinomas have a poor prognosis. Curative resec tions are usually performed with major liver resections. RM cholangiography is now the most efficient examination for selection of surgical indication s and choice of the best strategy. Long-term survival can be obtained with curative surgery. Adjuvant treatment has to be assessed by controlled trial s. (C) 2000 Editions scientifiques et medicales Elsevier SAS.