Clinical Presentation and Frequency of Klatskin Tumor; A Single-Center Retrospective Study

Öz

Clinical Presentation and Frequency of Klatskin Tumor; A Single-Center Retrospective Study Abstract Objective: Klatskin tumor is an epithelial bile duct tumor that originates from the main hepatic duct or the right-left intrahepatic duct and appears proximal to the opening of the cystic duct. In this study, we examined the demographic characteristics, clinical, laboratory and radiological results at the time of first presentation of patients who were diagnosed with klatskin tumor in our clinic for a period of three years. Materials and Methods: For the study; 16 patients who were hospitalized at Internal Medicine Clinic between June 1, 2015-May 1, 2018 were diagnosed with Klatskin tumor were included retrospectively. Clinical, laboratory and radiological data of patients were analyzed. Results: 16 patients in the study, 10 were male, 6 were female. Average age was 62.30 for males, 65.33 for females. The most common symptoms respectively jaundice, itching, abdominal pain, anorexia and weakness. Among the laboratory tests, the average of some values; AST:141.31 IU/L, ALT:156.18 IU /L, ALP:692.07 IU/L, GGT:622.14 IU/L, T. Bilirubin:10.42 mg/dl, D. Bilirubin: 6.0 mg/dl, WBC:10.509 x103µ/L. Diagnostic ERCPs of the patients were examined; Klatskin tumor was considered in 14 patients due to stenosis in the proximal part of the common bile duct. Conclusion: Clinical and laboratory findings in Klatskin tumors are not specific and the diagnosis is usually made in the late period because the clinical presentation of the disease is confused with many other diseases.

Anahtar Kelimeler

• Klatskin Tumor
• Cholangiocharcinoma
• ERCP
• Clinichal Presentation

Öz

Klatskin Tümörünün Klinik Sunumu ve Sıklığı; Tek Merkezli Retrospektif Bir Çalışma Özet Amaç: Klatskin tümörü ana hepatik kanaldan veya sağ-sol intrahepatik kanaldan köken alan ve kistik kanalın açıklığının proksimalinde görünen bir epitelyal safra kanalı tümörüdür. Bu çalışmada, kliniğimizde üç yıllık bir süre boyunca klatskin tümörü tanısı alan hastaların ilk başvuru anındaki demografik özellikleri, klinik, laboratuvar ve radyolojik sonuçları incelenmiştir. Gereç ve Yöntem: Çalışma için; 1 Haziran 2015-1 Mayıs 2018 tarihleri arasında Dahiliye Kliniğine yatırılan Klatskin tümörü tanısı konulan 16 hasta retrospektif olarak çalışmaya dahil edildi. Hastaların klinik, laboratuvar ve radyolojik verileri analiz edildi. Bulgular: Çalışmaya alınan 16 hasta, 10'u erkek, 6'sı kadındı. Ortalama yaş erkeklerde 62.30, kadınlarda 65.33 idi. En sık görülen semptomlar sırasıyla sarılık, kaşıntı, karın ağrısı, iştahsızlık ve halsizliktir. Laboratuvar testleri arasında bazı değerlerin ortalaması; AST:141.31 IU/L, ALT:156.18 IU/L, ALP:692.07 IU/L, GGT:622.14 IU/L, T. Bilirubin:10.42 mg/dl, D. Bilirubin: 6,0 mg/dl, WBC:10.509 x 103 µ/L. Hastaların tanısal ERCP'leri incelendi; Koledok proksimalinde darlık nedeniyle 14 hastada Klatskin tümörü düşünüldü. Sonuç: Klatskin tümörlerinde klinik ve laboratuvar bulgular spesifik olmayıp, hastalığın klinik prezentasyonu diğer birçok hastalıkla karıştırıldığı için tanı genellikle geç dönemde konulmaktadır.

Kaynakça

1. Referans1- Blechacz B, Gores GJ. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment. Hepatology 2008; 48(1): 308-21.
2. Referans2- Gatto M, Alvaro D. New insights on cholangiocarcinoma. World J Gastrointest Oncol 2010; 2(3): 136-145.
3. Referans3- Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet 2005; 366(9493): 1303-14.
4. Referans4- Seehofer D, Kmhues C, Neuhaus P: Resection of Klatskin tumors. Chirurg, 2012; 83(3): 221-8.
5. Referans5- Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994; 14(2):109-14.
6. Referans6- Jarnagin- W, Winston C. Hilar cholangiocarcinoma: Diagnosis and staging. HPB (Oxford). 2005; 7(4): 244-251.
7. Referans7- Anderson CD, Pinson CW, Berlin J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist. 2004; 9(1): 43–57.
8. Referans8- Aloia TA, Charnsangavej C, Faria S, Ribero D, Abdalla EK, Vauthey JN et al. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg. 2007; 193: 702-6.

9. Referans9- Liu CL, Lo CM, Lai EC, Fan ST. Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. Arch surg 1998; 133(3): 293-6.
10. Referans10- Friman S. Cholangiocarcinoma– current treatment options. Scand J Surg 2011; 100(1): 30-4.
11. Referans11- DeOliveira ML, Cunningham SC, Cameron JL et al. Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Ann Surg, 2007; 245(5): 755-62.
12. Referans12- Everhart JE, Ruhl CE. Burden of digestive diseases in the United States Part III: Liver, biliary tract, and pancreas. Gastroenterology, 2009; 136(4): 1134-44.
13. Referans13- Khan SA, Toledano MB, Taylor-Robinson SD. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB (Oxford), 2008; 10(2): 77–82.
14. Referans14- Gia L. Tyson, Jawad A. Ilyas, Zhigang Duan et al. Secular Trends in the Incidence of Cholangiocarcinoma in the USA and the Impact of Misclassification. Dig Dis Sci. 2014; 59(12): 3103-3110.
15. Referans15- Launois B, Reding R, Lebeau G, et al. Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg. 2000; 7(2): 128-34.
16. Referans16- Zografos GN, Farfaras A, Zagouri F, et al. Cholangiocarcinoma: principles and current trends. Hepatobiliary Panreat Dis Int 2011; 10(1): 10-20.
17. Referans17- Khan SA, Davidson BR, Goldin R, Pereira SP, Rosenberg WM, Taylor-Robinson SD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: Consensus document. Gut. 2002; 51(6): vi1-vi9.
18. Referans18- Christopher E. Forsmark, Allessandro L. Diniz, Andrew X. Zhu. Consensus Conference on the Multidisciplinary Management of Bile Duct Cance, HPB 2015; 17(8): 666–668.
19. Referans19- Harewood GC, Baron TH, Stadheim LM, Kipp BR, Sebo TJ, Salomao DR. Prospective, blinded evaluation of factors affecting the accuracy of biliary cytology interpretation. Am J Gastroenterol. 2004; 99(8): 1464-9.
20. Referans20- Weiss MJ, Cosgrove D, Herman JM, et al. Multimodal treatment strategies for advanced hilar cholangiocarcinoma. Langenbecks Arch Surg. 2014; 399(6): 679–92.
21. Referans21- Petrowsky H, Hong JC. Current surgical management of hilar and intrahepatic cholangiocarcinoma: the role of resection and orthotopic liver transplantation. Transplant Proc. 2009; 41(10): 4023-35.
22. Referans22- Nakeeb A, Pitt HA. Radiation therapy, chemotherapy and chemoradiation in hilar cholangiocarcinoma. HPB (Oxford). 2005; 7(4): 278–82.