Aims • klatskin tumors arise at the bile duct confluence, and constitute the most common type of cholangiocarcinomas. we retrospectively studied a series of 23 patients operated for Bismuth type III klatskin tumors and investigated the relations between clinicopathological features, postoperative bile leak and overall survival at 1, 3 and 5 years.

Methods • the hospital records were searched from 2006 till 2016 for operated type III klatskin tumors. All patients underwent resection of the hepatic ducts and regional lymphadenectomy, with a right hepatectomy for type IIIa in 12 patients and left hepatectomy for type IIIb in 11 patients.

Results & Conclusion • 63.6% of patients with type IIIb cholangiocarcinoma developed bile leakage postoperatively versus 25% of those with type IIIa, a correlation to be further investigated. R0 resection was achieved in 91.3% of the cases. two patients were lost to follow-up after 1 year due to traveling. two patients died in the hospital due to intraoperative complications. Overall 1-year survival was 90%, 3-year survival 47.6% and 5-year survival 19%. the studied population included 10 females and 13 males. Interestingly, during the first two years, 50% of female patients died, versus 20% of male patients. After five years, the difference in survival between genders was no longer significant. Regarding the pathological features, 7 patients had positive lymph nodes and 14 patients had negative lymph nodes. During the first two years, 85.7% of those who had positive nodes died, versus 50% of those with negative nodes. An elevated Pt INR level is associated with worse prognosis with statistical significance (p < 0.05). Although our data analysis is not yet complete, we are currently working on developing it further to understand the correlation among the studied variables. Our sample size reflects the work of a single surgeon, in the same institution during a 10-year follow-up. Few of the variables might be interesting to further analyze and might add to the literature additional questions on what affects both bile leak and survival in Bismuth type III klatskin tumors exclusively.

Keywords: Klatskin tumor; postoperative bile leak; survival