Personalized Palliative Management in Advanced Klatskin Tumors: A Case Report on Multiduct Stenting and Chemotherapy

Abstract

Klatskin tumors, a subtype of cholangiocarcinoma, arise at the hepatic bile duct bifurcation, leading to significant biliary obstruction and often late-stage diagnosis. A 62-year-old woman with a Bismuth type 3b Klatskin tumor presented with complaints of progressive jaundice, pruritus, and fatigue. Laboratory tests showed elevated bilirubin and cholestasis markers. Imaging revealed a 3.5 cm hilar mass, confirmed as cholangiocarcinoma. Due to advanced disease and impaired liver function, surgical resection was not an option. A palliative strategy involving endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, followed by gemcitabine and cisplatin chemotherapy, resulted in symptom relief and disease stabilization after four cycles. This case not only highlights the importance of personalized, minimally invasive approaches in managing advanced Klatskin tumors but also inspires with the potential role of emerging therapies, such as targeted treatments for genetic mutations, in the future management of unresectable cholangiocarcinomas.