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A retrospective review of correlative radiological assessment 
and surgical exploration for hilar cholangiocarcinoma

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):216-22
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Darren Chua1, Albert Low2, Yexin Koh1, Brian Goh1,3, Peng Chung Cheow1,3, Juinn Har Kam1,3,4, Jin Yao Teo1,3, Ek Khoon Tan1, Alexander Chung1,3, London Lucien Ooi1,3, Chung Yip Chan1,3, Ser Yee Lee1,3

Departments of 1Hepatopancreatobiliary and Transplant Surgery and 2Diagnostic Radiology, Singapore General Hospital, 3Duke-National University of Singapore Medical School, 
4Department of General Surgery, Sengkang General Hospital, Singapore 

Received January 3, 2018; Revised February 13, 2018; Accepted February 16, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Hilar cholangiocarcinomas (HCCAs) are tumors that involve the biliary confluence; at present, radical surgery offers the only chance of long-term survival, but this can be challenging given the complexity of the hilar anatomy. Blumgart and Jarnagin described a preoperative staging system that incorporates the effect of local tumor extent and its impact on adjacent structures and that has been demonstrated to correlate better with actual surgical resectability. The primary aim of this study is to describe the correlation between preoperative Blumgart-Jarnagin staging and its correlation with surgical resectability. 
Methods: Patients who underwent surgical resection for hilar cholangiocarcinoma at Singapore General Hospital between January 1, 2002, and January 1, 2013, were identified from a prospectively maintained institutional database. All patients were staged based on the criteria described by Blumgart and Jarnagin. Correlation with surgical resectability was then determined. 
Results: A total of 19 patients were identified. Overall resectability was 57.8% (n=11). Patients with Blumgart-Jarnagin stage T1 had the highest rates of resectability at 80%; patients with stage T2 and T3 disease had resectability rates of 25% and 40% respectively. Median overall survival was 13.6 months. Conclusions: The Blumgart-Jarnagin staging system is useful for predicting tumor resectability in HCCA.
Keywords : Klatskin; Blumgart-janargin; Resectability; Hilar cholangiocarcinoma; Pre-operative


February 2019, 23 (1)