Survival outcomes of hepatic resections in Bismuth-Corlette type IV cholangiocarcinoma

ANZ J Surg. 2020 Sep;90(9):1604-1614. doi: 10.1111/ans.15531. Epub 2019 Dec 15.


Background: Surgical resection for Bismuth-Corlette type IV (BC-IV) hilar cholangiocarcinomas, also termed Klatskin tumours are technically challenging and were once considered unresectable tumours. Following advances in hepatobiliary imaging and surgical techniques, emerging evidence suggests that surgical resection is a viable avenue for long-term survival. We aimed to identify factors affecting survival outcomes of hepatic resections for BC-IV cholangiocarcinomas.

Method: A systematic review was performed across multiple databases and several clinical trial registries. Two reviewers independently screened and selected papers that contained survival data on BC-IV cholangiocarcinoma after hepatic resections.

Results: Of 13 499 papers from our search result, 21 papers satisfied the inclusion criteria. The median post-operative survival was 30.8 months. The average 1- and 5-year post-operative survivals were 61.6 and 33.3%, respectively. Predictors of long-term survival included achievement of R0 margins, minimisation of operative time and reduction intra-operative blood loss.

Conclusion: Our analysis demonstrates improving post-operative outcomes and survival in surgical resection of BC-IV cholangiocarcinoma and suggests that radical surgical resection is a valid treatment option for the disease.

Keywords: bile duct neoplasm; cholangiocarcinoma; hepatectomy; hilar carcinoma; survival outcome.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Bile Duct Neoplasms* / diagnostic imaging
  • Bile Duct Neoplasms* / surgery
  • Bile Ducts, Intrahepatic / surgery
  • Bismuth
  • Cholangiocarcinoma* / diagnostic imaging
  • Cholangiocarcinoma* / surgery
  • Hepatectomy
  • Humans
  • Retrospective Studies
  • Treatment Outcome


  • Bismuth