Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter?

Abstract

Background: The only potentially curative option for patients with perihilar cholangiocarcinoma (PHC) is resection, typically an extrahepatic bile duct resection in combination with (extended) liver resection.Complications such as bile leakage and liver failure have been suggested to be more common after rightsided resections compared to left-sided resections, whilst superior oncological outcomes have been reported after right-sided resections. However, data on outcomes after right-sided or left-sided liver resections in PHC are scarce. Therefore, we aimed to investigate short-and long-term outcomes after left and right hemihepatectomy in patients with PHC.Methods: In this retrospective study, patients undergoing major liver resection for suspected PHC in a tertiary center between 2000-2018 were included. Patients who had undergone left-sided resections were compared to patients with right-sided resections in terms of complications (90-day mortality, overall and severe morbidity and specific complications). For long-term outcomes, only patients with pathologically proven PHC were included in the survival analysis.Results: A total of 178 patients undergoing hemihepatectomy for suspected PHC were analysed, including 76 left-sided and 102 right-sided resections. Overall 90-day mortality was 14% (24 out of 178), with no significant difference after left-sided resection (11%; 8 out of 76) versus right-sided resection (16%; 16 out of 102) (P=0.319). Severe morbidity (Clavein Dindo ≥3) was also comparable in both groups: 54% versus 61% (P=0.361). No differences in specific complications including bile leakage were observed, although liver failure appeared to occur more frequently after right hemihepatectomy (22% versus 11%, P=0.052). Fiveyear overall survival for pathologically proven PHC, excluding in-hospital mortality, did not differ; 43.7% after left-sided resection vs. and 38.2% after right-sided resection (P=0.553).Conclusions: Both short-and long-term outcomes between patients undergoing left and right hemihepatectomy for PHC were comparable. Post-hepatectomy liver failure was more common after rightsided resection.

Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma

“…On the other hand, previous authors suggested that right hepatectomy would be associated with better long-term survival because right hepatic pedicle resection enables better radicality compared with left resections (14,34,35). A recent review however, showed no survival benefit after either right or left resection for PHCC (36). This study has several limitations.…”

Exploring the function of stromal cells in cholangiocarcinoma by three-dimensional bioprinting immune microenvironment model

“…Cholangiocarcinoma (CCA) is the most common biliary malignancy and the second most common primary liver malignant tumor, only after hepatocellular carcinoma ( 1 , 2 ). CCA accounts for 10–20% of deaths due to hepatobiliary malignancies ( 3 , 4 ). Usually, early diagnosis of CCA is challenging, as it has no specific symptoms; thus, it is mostly diagnosed at an advanced stage.…”

Perihilar-cholangiocarcinoma: what really matters?

“…The decision to either perform a right or left hepatectomy should be based on several factors, including tumor extension, presence of vascular infiltration, study of the future liver remnant (FLR) and center experience. Franken and colleagues reported their valuable experience with patients affected by PHC ( 2 ), comparing 76 left sided liver resections (LH) vs. 102 right sided liver resections (RH) for PHC, to highlight potential advantages of one approach over the other. Authors showed that no statistically significant differences could be found in both short- and long-term outcomes between the two groups.…”