Long-term results of endoscopic treatment in inoperable Klatskin tumor patients

Öz

Background and Aims: Klatskin tumor is an epithelial biliary duct tumor arising from main hepatic duct or left-right intrahepatic duct and is proximal to the cystic duct opening. The diagnosis of the disease is late and life expectancy is low. Palliative procedures like endoscopic or percutaneous biliary drainage for the drainage of bile are used for patients contraindicated for surgery. In this study, we aimed to evaluate the efficiency of procedures and survival in the inoperable Klatskin tumor patients given palliative treatment with endoscopic stent and/or percutaneous drainage. Materials and Methods: This study was done retrospectively in the Gastroenterology Department of İzmir Atatürk Training and Research Hospital between January 2008 and September 2009. Thirty-four inoperable hilar cholangiocarcinoma patients were included in the study. The classification of disease was done according to Bismuth classification. Results: Nineteen females and 15 males were included in the study. The mean age was 71.8±8.9 years. The drainage was inadequate in 7 (21%) patients. Percutaneous drainage catheter was placed in 2 (6%) of the patients in whom drainage failed. The decrease in bilirubin levels was not sufficient in percutaneous drainage-applied patients. Mean survival was 145±138 days in patients with adequate drainage with endoscopic stenting versus 13.2±7 days in 5 patients with insufficient drainage and who did not permit percutaneous drainage. Mean survival in the 2 percutaneous drainage-applied patients due to insufficient drainage after stenting was 22±11.3 days. Mean survival was 164.2±19.3, 86±125.6, 134.7±130.8, and 89.3±132.5 days in Bismuth-classified 1, 2, 3, and 4 patients, respectively. There was no statistical difference between groups according to Bismuth classification (p=0.317). Conclusions: In this study, we determined that the success rate of endoscopic treatment was high and the localization of tumor was not effective on average survival. However, we believe that stenting can contribute to average survival in a palliative manner, and a minimum of two sessions of endoscopic retrograde cholangiopancreatography should be attempted to provide palliative drainage in patients.

Anahtar Kelimeler

• Klatskin tumor, ERCP, drainage, palliative treatment

İnoperabl Klatskin tümörlü hastaların endoskopik tedavi ile uzun dönem sonuçları

Öz

Giriş ve Amaç: Klatskin tümörü ana hepatik kanal ya da sağ-sol intrahepatik kanaldan köken alan ve sistik kanalın açılım yerinin proksimalinde görülen epitelyal safra yolu tümörüdür. Hastalığın tanısı geç konur ve yaşam beklentisi düşüktür. Cerrahi için uygun olmayan hastalarda safranın drenajının sağlanması amacıyla endoskopik ya da perkütan drenaj gibi palyatif tedavi seçenekleri kullanılmaktadır. Bu çalışmada, endoskopik stent ve/veya perkütan drenaj tedavisi ile palyatif tedavi edilen inoperabl Klatskin tümörlü hastaların yaşam sürelerini ve işlemlerinin etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışma, İzmir Atatürk Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği'nde Ocak 2008Eylül 2009 tarihlerinde retrospektif olarak yapıldı. Çalışmaya inoperabl hiler kolanjiokarsinomalı 34 hasta dahil edildi. Bismuth sınıflaması göz önüne alınarak hastalığın tipi belirlendi. Bulgular: Çalışmaya 19 kadın, 15 erkek hasta dahil edildi, ortalama yaş 71.8±8.9 olarak bulundu. Yedi hastada (%21) yeterli drenaj olmadı. Drenaj sağlanamayan hastalardan 2'sine (%6) perkütan drenaj kateteri yerleştirildi. Perkütan transhepatik kolanjiografi yapılan hastalarda yeterli bilirubin düşüşü izlenmedi. Endoskopik stent sonrası drenajın yeterli olduğu hastalarda ortalama yaşam süresi 145±138 gündü. Stentleme sonrası yeterli drenaj olmayan ve perkütan transhepatik kolanjiografiyi kabul etmeyen 5 hastada ortalama yaşam süresi 13.2±7 gündü. Stentleme sonrası yeterli drenaj olmaması sebebiyle perkütan transhepatik kolanjiografi ile dren yerleştirilen 2 hastada ortalama yaşam süresi 22±11.3 gündü. Bismuth I hastalarda ortalama yaşam süresi 164.2±19.3, Bismuth II hastalarda 86±125.6, Bismuth III hastalarda 134.7±130.8, Bismuth IV hastalarda 89.3±132.5 gün saptandı. Bismuth'a göre gruplar arasında yaşam süreleri açısından anlamlı fark saptanmadı (p=0.317). Sonuç: Bu çalışmada, palyatif endoskopik tedavi başarı oranının yüksek olduğunu ve tümörün yerleşim yerinin ortalama yaşam süresi üzerinde etkili olmadığını saptadık. Ancak stentlemenin, palyatif anlamda ortalama yaşam süresine katkıda bulunabileceğini ve en az 2 endoskopik retrograd kolanjiografi seansının hastaların palyatif drenajını sağlamak için denenmesi gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Klatskin tümörü, ERCP, drenaj, palyatif tedavi

Kaynakça

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