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CION Cancer Clinics
Surgery for a Klatskin tumour: what is removed and who it suits | CION Cancer Clinics
Surgery for a perihilar bile duct cancer, or Klatskin tumour, removes the affected bile duct, the nearby lymph glands and usually one side of the liver. The remaining ducts are then joined to the bowel. This page explains why so much is taken, what the team checks before agreeing to operate, what happens first, and who this operation does not suit. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- What is removed in surgery for a Klatskin tumour?
- What does the team look at to decide if surgery is possible?
- What happens between diagnosis and the operation?
- How does surgery compare with the other options?
- Who is this operation not suitable for?
- What this page cannot tell you
- Common questions about perihilar bile duct surgery
The short answer
What is removed in surgery for a Klatskin tumour?
The surgeon removes the bile duct where the tumour sits, the nearby lymph glands and, in almost every case, one side of the liver along with the small lobe behind it, called the caudate lobe. The remaining bile ducts are then joined to a loop of small bowel so bile can drain again.
Why so much is taken
A perihilar cholangiocarcinoma, often called a Klatskin tumour, grows where the right and left bile ducts meet just below the liver. It tends to creep along the duct walls into the liver on one or both sides. Removing only the duct usually leaves cancer behind at the edges, so the side of the liver it is spreading into goes with it.
Which bile duct cancer this page is about
This page is about the cancer at the junction, the hilum. A tumour lower down, near the pancreas, needs a different operation, explained on our page on the Whipple operation for distal bile duct cancer. A tumour inside the liver itself is a third kind, covered under intrahepatic cholangiocarcinoma.
This is major surgery. It is offered only when the team believes the whole tumour can be removed and enough healthy liver will be left.Before anyone says yes
What does the team look at to decide if surgery is possible?
Most of the decision is made on the scans, before anyone operates. Three questions matter most.
How far up the ducts it reaches
An MRI with MRCP, a scan that shows the bile ducts, maps how far the tumour has spread up each side. If it reaches deep into both sides of the liver, removing it cleanly may not be possible.
The blood vessels next to it
The portal vein and hepatic artery run right beside the hilum. A triple-phase CT shows whether the tumour is wrapped around them. Some vessel involvement can be repaired during surgery. Some cannot.
How much liver will be left
The part that stays is called the future liver remnant. If it looks too small, the team may plan a procedure first to make it grow.
The team also checks
- Whether the cancer has spread to distant glands or organs
- Your fitness for a long anaesthetic
- Whether the jaundice has been brought down first
The tumour's DNA
Bile duct cancers should have molecular profiling, testing of the tumour's DNA, because some carry changes that open targeted options later. It does not promise one. See why every biliary cancer should be tested.
Not sure whether this applies to you?
Ask an oncologistThe road to the operation
What happens between diagnosis and the operation?
Draining the bile first
Most people arrive yellow. A stent placed through an endoscope, or a thin drain placed through the skin, lets bile flow again. Operating on a liver soaked in bile is riskier, so this usually comes first. Read why a stent comes before treatment.
Growing the liver if needed
If the remaining liver looks too small, the vein feeding the side to be removed can be blocked. The other side then grows over the following weeks. This is called portal vein embolisation.
The operation
An open operation under general anaesthetic, usually lasting most of a day. The surgeon may check for spread first and stop if the tumour cannot be fully removed. Your team will tell you where the operation takes place.
Recovery and the pathology report
A stay in high-dependency care, then the ward. The removed tissue is examined to see whether the edges are clear. That report shapes what comes next, including whether chemotherapy is advised after surgery.
Side by side
How does surgery compare with the other options?
Surgery to remove it
Treatment without surgery
The only treatment that aims to remove the whole cancer
Aims to control the cancer and the symptoms for as long as possible
Needs a tumour that can be cleared with enough liver left
Suits tumours that reach too far or have spread
Major operation with a long recovery
Stents, chemotherapy, immunotherapy and sometimes radiation
Often followed by chemotherapy tablets or drips
Transplant only in rare, carefully chosen cases
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Honest limits
Who is this operation not suitable for?
Many people with a perihilar tumour are not offered surgery, and that is not a failure of effort. It is not suitable when the cancer has spread to the liver in several places, to the lining of the abdomen, or to distant glands. It is not suitable when the tumour reaches deep into both sides of the liver, or surrounds the main vessels on the side that would be kept.
When the liver or the body is not ready
Advanced cirrhosis, or a remnant that will not grow enough, makes the operation too dangerous. So can serious heart or lung disease. Ongoing infection in the bile ducts, called cholangitis, must settle before any surgery is planned.
What happens instead
If surgery is not possible, treatment still matters. Keeping the bile draining, chemotherapy combined with immunotherapy, and symptom care can give real time with good quality. Our page on treatment when bile duct cancer cannot be removed explains the options.
Being straight with you
What this page cannot tell you
It cannot tell you whether your tumour can be removed. That decision depends on the exact detail of your scans, measured by surgeons and radiologists who have seen the images, not only the report. Two people with the same words on their report can get different answers.
It cannot predict how you will do
Recovery and the outlook after this operation vary widely from person to person. Your surgical oncologist can talk through what is likely for you, once the full picture is known.
Where CION fits
CION's surgical oncologists assess and plan liver and bile duct operations, and every case is discussed at the tumour board. Scans, drainage procedures and the operation itself are arranged through accredited partner hospitals. Chemotherapy after surgery and follow-up are given at CION centres.
If you have been told surgery is not possible and want a second view of the scans, ask the helpline for a surgical opinion.Questions we are asked
Common questions about perihilar bile duct surgery
Is a Klatskin tumour the same as liver cancer?
No. It is a cancer of the bile duct, the tube that carries bile out of the liver. It sits where the ducts meet just below the liver, which is why surgery so often involves the liver too. It is treated differently from hepatocellular carcinoma, the commonest cancer that starts in liver cells.
Will I be able to live with half my liver removed?
Yes, if enough healthy liver is left. The liver regrows over the following months. That is why the team measures the remaining part carefully on the scan beforehand, and sometimes blocks a vein first to make it grow before the operation.
Why do I need a stent or drain before surgery?
A liver blocked with bile heals poorly and is more likely to fail after a large operation. Draining the bile first lets the jaundice settle and the liver recover. It also helps the itching and lets you eat better before surgery.
Can this operation be done by keyhole surgery?
It is usually done as an open operation, because the area around the hilum is crowded with vessels and the joins to the bowel are delicate. A few specialist teams do some of these by keyhole or robotic methods. Your surgeon will tell you which approach suits your tumour.
What if the surgeon finds spread during the operation?
The surgeon may look first, sometimes with a camera, before committing to the full operation. If spread is found, the larger operation is not continued, because it would not help. Your team will then plan drainage and treatment that does not involve surgery.
Will I need chemotherapy after surgery?
Often, yes. Chemotherapy after the operation is commonly advised to lower the chance of the cancer coming back. The final pathology report and your recovery guide the decision. It is given at CION centres once you are well enough.
Is a liver transplant an option instead?
Only rarely. A small number of carefully selected people with a perihilar tumour are considered for transplant at licensed transplant centres, usually after other treatment first. Read transplant for perihilar bile duct cancer to understand why it is uncommon.
How do I get my scans reviewed by a surgeon?
Bring the scan discs and reports, not only the printed pages, along with any stent or drain details. Call the CION helpline and ask for a surgical oncology opinion. Your case can then be discussed at the tumour board and the next step explained plainly.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Bile Duct Cancer Surgery
- National Cancer Institute — Bile Duct Cancer Treatment
- Cancer Research UK — Treatment for bile duct cancer
- American Cancer Society — Bile Duct Cancer Targeted Therapy
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Perihilar cholangiocarcinoma and the Klatskin tumourWhat this cancer is, before the operationPortal vein embolisation before bile duct surgeryHow the liver is made to grow before surgeryHow perihilar bile duct cancer is stagedThe staging that decides whether surgery is possibleBile duct resection for cholangiocarcinomaThe operation itself, step by step
Talk to us
Have you been told the tumour may or may not be removable?
Send us your scans and reports and a surgical oncologist will review them with the tumour board. We will explain what is possible in plain words. One helpline serves every CION centre.