چکیده (انگلیسی):

Introduction: The aim of this study was to identify clinical, laboratory and radiological parameters to
distinguish benign from malignant stenoses of the proximal bile duct.
Methods: Between 1997 and 2011, 250 patients were referred to our clinic with hilar bile duct stenoses
suspicious for Klatskin tumour. Medical histories, clinical data, pre-interventional laboratory tests, imaging
findings, as well as therapeutic approach and patient outcome were compared to final histological
results. All data were retrieved from our prospectively maintained database and analysed retrospectively.
Results: We found benign bile duct lesions in 34 patients (13.6%). Among the entire study population,
uni- and multivariate analyses of 18 clinicopathological parameters revealed that patient age, serum
alkaline phosphatase, tumour marker CA19-9 and presence of tumour mass in computed tomography
were independent predictors for malignant biliary stenoses (p < 0.05). Receiver operator characteristic
curve showed that a CA19-9 serum level of 61.2 U/ml or more has a sensitivity, specificity and diagnostic
accuracy for predicting the malignant nature of the hilar biliary stenoses of 74.6%, 80.0% and 83.5%,
respectively. Surgical resection could be avoided by preoperative work-up and surgical exploration in 10
out of 34 patients with benign lesions. Rates of major liver resections performed were 66.7% in the
benign lesion group and 90.7% in the Klatskin tumour group.
Conclusion: Despite improvements of preoperative diagnostics, it remains difficult to differentiate between
benign and malignant hilar bile duct stenosis. Even explorative laparotomy was not able to safely
exclude Klatskin tumour in all cases and therefore major liver resection was inevitable.