Management of hepatic duct tumors at the biliary confluence or the Klatskin tumors as they are called is a diagnostic and therapeutic dillema.
Diagnostic dillema because most of the available investigations can not differentiate between benign and malignant lesions. Although all suspicious lesions should be considered malignant and treated as such, there is a 5-10 % chance that these lesions turn out to be benign on Histopathological analysis.
The term malignant masquerade has been coined for such lesions.
Treatment options depend on the satge of the disease
There are various staging systems
1. Bismuth- Corlette classification comparative stratification of tumor spread along the bile ducts but does not address portal vein or hepatic artery involvement
2. A new preoperative staging system developed by Burke
Degree of biliary involvement
Hepatic lobar atrophy
Ipsilateral or bilateral portal vein involvement
Proposed T stage criteria for hilar cholangiocarcinoma Stage Criteria
T1 Tumor confined to confluence and/or right or left hepatic duct without portal vein
involvement or liver atrophy
T2 Tumor confined to confluence and/or right or left hepatic duct with ipsilateral liver atrophy No portal vein involvement demonstrated
T3 Tumor confined to confluence and/or right or left hepatic duct with ipsilateral portal
venous branch involvement with/without associated ipsilateral lobar liver atrophy. No main portal vein involvement (occlusion, invasion, or encasement)
T4 Any of the following: (1) tumor involving both right and left hepatic ducts up to the
secondary radicals bilaterally, or (2) main portal vein encasement
Burke EC, Jarnagin WR, et al. Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system.
Ann Surg 1998;228(3):385–94
