Left- versus right-sided hepatectomy with hilar en-bloc resection in perihilar cholangiocarcinoma

Bednarsch, Jan; Czigány, Zoltán; Lurje, Isabella; Tacke, Frank; Strnad, Pavel; Ulmer, Tom Florian; Gaisa, Nadine T.; Bruners, Philipp; Neumann, Ulf; Lurje, Georg

doi:10.1016/j.hpb.2019.07.003

Cited by 34 publications

(62 citation statements)

References 24 publications

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“…In contrast, palliative treatment modalities such as systemic chemotherapy result in a significantly inferior oncological outcome 7 . However, due to its direct proximity to major vascular structures of the liver hilus, surgical therapy of pCCA patients remains challenging and often displays significant perioperative mortality rates exceeding 10% 6,[8][9][10] . Given the extraordinarily high perioperative morbidity and mortality in these individuals, preoperative endoscopic biliary drainage (EBD) or percutaneous biliary drainage (PBD) are commonly used to release the pressure in the bile duct system, improve the liver function and promote postoperative functional recovery 11,12 .…”

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confidence: 99%

“…Bacterial bile duct colonization and cholangitis might also lead to postoperative abdominal infections with the risk to cause bacterial sepsis with often fulminant or even fatal complications and a reduced functional recovery of the remnant liver 16 . Previous reports have identified abdominal infections as a major source of adverse clinical outcomes, playing a key role in the development of postoperative complications, post-hepatectomy liver failure, and vascular complications 6,[8][9][10] .…”

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confidence: 99%

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Bacterial bile duct colonization in perihilar cholangiocarcinoma and its clinical significance

Bednarsch

Czigány

Heij

et al. 2021

Sci Rep

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Abdominal infections including cholangitis represent a major problem in patients with perihilar cholangiocarcinoma (pCCA). Thus, we investigated bacterial colonization of the bile ducts and determined its impact on postoperative outcome focusing on abdominal infections. A cohort of 95 pCCA patients who underwent surgery between 2010 and 2019 with available intraoperative microbial bile cultures were analyzed regarding bile duct colonization and postoperative abdominal infection by group comparisons and logistic regressions. 84.2% (80/95) showed bacterial colonization of the bile ducts and 54.7% (52/95) developed postoperative abdominal infections. Enterococcus faecalis (38.8%, 31/80), Enterococcus faecium (32.5%, 26/80), Enterobacter cloacae (16.3%, 13/80) and Escherichia coli (11.3%, 9/80) were the most common bacteria colonizing the bile ducts and Enterococcus faecium (71.2%, 37/52), Enterococcus faecalis (30.8%, 16/52), Enterobacter cloacae (25.0%, 13/52) and Escherichia coli (19.2%, 10/52) the most common causes of postoperative abdominal infection. Further, reduced susceptibility to perioperative antibiotic prophylaxis (OR = 10.10, p = .007) was identified as independent predictor of postoperative abdominal infection. Bacterial colonization is common in pCCA patients and reduced susceptibility of the bacteria to the intraoperative antibiotic prophylaxis is an independent predictor of postoperative abdominal infections. Adapting antibiotic prophylaxis might therefore have the potential to improve surgical outcome pCCA patients.

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confidence: 99%

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Bacterial bile duct colonization in perihilar cholangiocarcinoma and its clinical significance

Bednarsch

Czigány

Heij

et al. 2021

Sci Rep

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“…Based on segmental anatomy, extended right hemihepatectomy is the most commonly performed procedure for pCCA, with the highest percentage of R0 resections [33]. However, two recent publications showed no difference between short- and long-term outcomes between patients undergoing left or right hemihepatectomy with or without caudate lobectomy [34, 35]. In addition, a recent systematic review by Pinotti et al [36] stated that caudate lobectomy may improve the R0 resection rate and OS in patients with pCCA and thus should be considered.…”

Section: Surgerymentioning

confidence: 99%

“…In addition, a recent systematic review by Pinotti et al [36] stated that caudate lobectomy may improve the R0 resection rate and OS in patients with pCCA and thus should be considered. In conclusion, although overall no survival benefit was found after either right or left resection, (extended) right hemihepatectomy with caudate lobectomy may lead to a slightly higher rate of radical resections, but is also hampered by a higher percentage of post-hepatectomy liver failure [34, 35].…”

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confidence: 99%

Surgical Therapy for Perihilar Cholangiocarcinoma: State of the Art

et al. 2021

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Background: Surgical therapy still offers the only chance of long-term survival for patients with perihilar cholangiocarcinoma (pCCA). The aim of this narrative review is to summarize the current standards and challenges in the surgical treatment of pCCA. Summary: After imaging and defining resectability, the first step towards optimal surgical treatment is optimizing biliary drainage and preventing cholangitis, followed by securing adequate future liver remnant volume and/or function. The main goal of resection for pCCA is achieving radical resection and ultimately long-term survival. In order to achieve radical resection, several points will be addressed (e.g., vascular resection and reconstruction, intraoperative frozen sections, right versus left hemihepatectomy, and the usefulness of preoperative [chemo]therapy). Key Messages: In order to optimize long-term outcomes for patients with pCCA, collaboration between leading centers should be increased. In addition, this collaboration is necessary to design large prospective randomized controlled trials, as the incidence of pCCA is low and the number of resectable patients is even lower. Currently, most results are based on small retrospective cohort studies resulting in low evidence. In order to properly investigate how to improve long-term survival, we need to set up trials to confirm the results of small series suggesting the positive effect of preoperative chemotherapy and extended lymph node resection.

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“…Eventually, 11 eligible cohort studies were included in this analysis. 15,19,[28][29][30][31][32][33][34][35][36] Characteristics of included studies and assessment of methodological quality The 11 eligible retrospective-prospective cohort studies were carried between 2001-2020, including a total of 1031 patients. All studies were single-center studies, most of them (7/11) were performed in Asian populations (Japan, Korea, and India), and the rest (4/11) were based on Western populations (Germany, Italy, and USA).…”

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confidence: 99%

Left-side vs. right-side hepatectomy for Hilar Cholangiocarcinoma: A meta-analysis

Cheng

Chen

et al. 2021

Preprint

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Goals: We aim to draw a conclusion which type of hepatectomy could be the priority for hilar cholangiocarcinoma patients.Background: Surgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which includes left hemihepatectomy, extended left hemihepatectomy and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma.Study: We systematically retrieved the MEDLINE, PubMed and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and secondary outcomes include 1-, 3-, and 5-Year survival rates, morbidity, mortality, R0 resection rate and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis.Results: Eleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients underwent left-side hepatectomy was comparable to that of patients underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98-1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89-1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80-1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67-1.01]) rates between left-side hepatectomy group and the right-side hepatectomy group. Comparing with right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71-0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56-0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09-0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23-0.70]) in left-side hepatectomy group was better than that of right-side hepatectomy group. Besides, the R0 resection rate was similar between left-side hepatectomy group and right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87-1.03]). And the operation time for left-side hepatectomy were significantly longer than those for right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41-69.95]).Conclusion: Through meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in left-side hepatectomy group as is compared to right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy had better depend on the site of hilar cholangiocarcinoma in every patient.

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Left- versus right-sided hepatectomy with hilar en-bloc resection in perihilar cholangiocarcinoma

Cited by 34 publications

References 24 publications

Bacterial bile duct colonization in perihilar cholangiocarcinoma and its clinical significance

Bacterial bile duct colonization in perihilar cholangiocarcinoma and its clinical significance

Surgical Therapy for Perihilar Cholangiocarcinoma: State of the Art

Left-side vs. right-side hepatectomy for Hilar Cholangiocarcinoma: A meta-analysis

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