When is an endoscopic intervention allowed in Klatskin tumor cases?

Aim: The optimal treatment of Klatskin tumor is surgery. Our aim was to assess via retrospective analysis, the operability, complications of endoscopic interventions and survival of patients diagnosed with Katskin tumor and also the adequacy of their examination algorithm and whether the biliary interventions affected survival. Method: Analysis period: 2013. Inclusion criterion: all Klatskin tumors diagnosed within the analysis period. Exclusion criteria: hilar biliary obstruction caused by cholecyst tumor, metastasis or inflammation and operability. The number of patients was not sufficient to employ statistical methods, therefore we attempted to find answers by case analyses. Results: Case number: 7, average age: 74.7 years (58 – 98 years), 4 female and 3 male patients. Average survival: 3 months from start of examination. The first ultrasonography exposed hilar tumor at 2 patients. With 6 patients the second examination (CT) confirmed a hilar process and in one case no CT was performed. In 1 case out of 7 MR- cholangiopancreatography (MR-CP) was performed. As a third examination endoscopic retrograde biliary intervention was performed in all cases and in 4 cases we carried out percutaneous transhepatic drainage (PTD). ERCP was the first intervention in all cases, after which cholangitis occurred in all cases. In 3 cases we decided that the deformation was inoperable. In 4 cases an operation was carried out. 1 patient survives. The resection edge was not tumor-free. Oncology treatment was administered. 3 patients died during the postoperative period. 2 of the inoperable patients exited within 1 month due to septic complications. In 1 case death was caused by tumor progression and PTD dislocation. Biliary interventions reduced the total bilirubin level significantly in the 2 cases only where ERCP+PTD had been performed. Conclusion: A simple abdominal ultrasonography should be sufficient to detect the location of biliary obstruction. The examination procedure was not in line with international standards (CT should be followed by PTC or MR-CP). If the location of the obstruction is known, ERCP is prohibited because each ERCP was followed by biliary infection. The death of inoperable patients within 30 days and death of the majority of patients during the postoperative period was explained by the frequency of postoperative complications that occurred after ERCP.