KLATSKIN’S TUMOR: PREVALENCE, FEATURES OF DIAGNOSIS AND TREATMENT TACTICS (REVIEW)

D.R. Sanginov1,2, S.M. Akhmedov3, A.A. Khudzhamkulov2

1Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

2Republican Oncology Research Center, Dushanbe, Republic of Tajikistan

3Institute of Gastroenterology, Dushanbe, Republic of Tajikistan

Sanginov Dzhumaboy R. ― Doct. of Sci. (Med.), Professor of the Department of Oncology, Radiation Diagnostics and Radiation Treatment of the Avicenna Tajik State Medical University

29-31 Sino Str., Dushanbe, 734003, Republic of Tajikistan, e-mail: sanginov1952@gmail.com, Researcher ID: AAH-2351-2021, ORCID ID: 0000-0002-4311-3094, SPIN-code: 3535-1025, Author ID: 1099938

Abstract. The presented literature review examines the situation related to the prevalence, increase in incidence, and mortality from cholangiocellular cancer in the world. An analysis of available sources was carried out using electronic databases PubMed, MEDLINE, Science Direct, Scopus, Web of Science, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI. Over 30 000 sources were found, of which 50 works over the past 10 years were selected and included in the article. The criteria for inclusion in the review were works that dealt with issues of early diagnosis, prevalence, clinical features, treatment tactics and survival of patients with cholangiocellular carcinoma.

An increasing trend in the risk of cholangiocellular carcinoma incidence from the age of 50-60 years was revealed. An analysis of the situation in the Republic of Tajikistan showed an increasing trend in the incidence of malignant tumors of the liver and bile ducts, amounting to 1,45 per 100 thousand population in 2022, slightly more in men than in women. Based on the results of a retrospective analysis of our material for 2009-2017. The majority of patients were in the age category of 44-60 years.

Klatskin tumor (KT) often becomes unresectable at the stage of preclinical manifestations, which is associated with the development of intra- and extrahepatic metastases, invasion of great vessels and adjacent nerves. The rate of R0 resection in leading specialized centers remains low, amounting to 60%, with 5-year overall survival rates of 75%, disease-free survival of 25,8%, with a relatively high relapse rate of up to 55%. The shortcomings of existing models for predicting patient survival are associated with the lack of unification of risk factors. Early diagnosis of a tumor increases the chances of radical treatment. However, the high incidence of neglect requires preoperative or palliative bile duct decompression in the vast majority of patients.

Surgical resection provides the best long-term survival results with a high risk of postoperative complications. The main goal of surgery is to achieve R0 resection, which often requires extended liver resection with vascular or biliary reconstruction. The effectiveness of adjuvant chemoradiotherapy, immunotherapy, targeted therapy and gene therapy requires further research. The introduction of minimally invasive approaches is a moment of incentive in solving the problem of Klatskin tumor. In the near future, the role of liver transplantation must find its solution.

Key words: Klatskin tumor, prevalence, features of early diagnosis, treatment tactics, prognosis, survival.