Impact of surgery on survival outcomes for Bismuth type IV Klatskin tumors

Yoo Jin Choi, Jung Min Lee, Jae Seung Kang, Hee Ju Sohn, Yoonhyeong Byun, Youngmin Han, Hongbeom Kim, Wooil Kwon, Jin Young Jang

Research output: Contribution to journalArticlepeer-review


Background: Bismuth–Corlette type IV Klatskin tumors have conventionally been considered unresectable. This retrospective study aimed to demonstrate the survival improvement of patients with type IV Klatskin tumors when resected and suggest possible radiological features for R0 resectability. Methods: Data on type IV Klatskin tumors diagnosed between 2008 and 2019 were reviewed retrospectively. Patients with distant metastasis, concomitant other cancers at the initial state, extensive vascular invasions, poor liver function, and poor general condition were excluded. The survival outcomes of patients and radiologic parameters of bile duct tumors were compared between the curative resection (R0, 1 resection) and non-resection groups. Results: The demographic findings of patients with curative resection (n = 48) and non-resection (n = 111) were comparable. Both were potentially resectable in the initial state. The postoperative morbidity was 22.9% and the 90-day mortality 4.2%. There was a significant difference in the median survival among the curative-intended resection, palliative treatment, and supportive care groups (35, 16, and 12 months, respectively; P < 0.001). Discussion: In patients with type IV Klatskin tumor without extensive tumor invasion into adjacent tissues, including major vessels, surgical resection can be considered for better survival. Clinical registration number: IRB No.

Original languageEnglish
Pages (from-to)1890-1898
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - Sep 2022


  • Bile duct neoplasm
  • Hepatectomy
  • Hilar cholangiocarcinoma
  • Klatskin
  • Surgical resection


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