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. 2018 Nov;22(4):350-358.
doi: 10.14701/ahbps.2018.22.4.350. Epub 2018 Nov 27.

Comparison analysis of left-side versus right-side resection in bismuth type III hilar cholangiocarcinoma

YouJin Lee  1 , DongWook Choi  1 , Sunjong Han  2 , In Woong Han  1 , Jin Seok Heo  1 , Seong Ho Choi  1
Affiliations

Comparison analysis of left-side versus right-side resection in bismuth type III hilar cholangiocarcinoma

YouJin Lee et al. Ann Hepatobiliary Pancreat Surg. 2018 Nov.

Abstract

Backgrounds/aims: Several studies report worse prognosis after left-side compared to right-side liver resection in patients with perihilar cholangiocarcinoma. In this study, we compared outcomes of left-side and right-side resections for Bismuth type III hilar cholangiocarcinoma and analyzed factors affecting survival.

Methods: From May 1995 to December 2012, 179 patients underwent surgery at Samsung Medical Center for type III hilar cholangiocarcinoma. Among these patients, 138 received hepatectomies for adenocarcinoma with curative intent: 103 had right-side resections (IIIa group) and 35 had left-side resections (IIIb group). Perioperative demographics, morbidity, mortality, and overall and disease-free survival rates were compared between the groups.

Results: BMI was higher in the IIIa group (24±2.6 kg/m2 versus 22.7±2.8 kg/m2; p=0.012). Preoperative portal vein embolization was done in 23.3% of patients in the IIIa group and none in the IIIb group. R0 rate was 82.5% in the IIIa group and 85.7% in the IIIb group (p=0.796) and 3a complications by Clavien-Dindo classification were significantly different between groups (10.7% for IIIa versus 23.3% for IIIb; p=0.002). The 5-year overall survival rate was 33% in the IIIa group and 35% in the IIIb group (p=0.983). The 5-year disease-free survival rate was 28% in the IIIa group and 29% in the IIIb group (p=0.706). Advanced T-stages 3 and 4 and LN metastasis were independent prognostic factors for survival and recurrence by multivariate analysis.

Conclusions: No significant differences were seen in outcomes by lesion side in patients receiving curative surgery for Bismuth type III hilar cholangiocarcinoma.

Keywords: Hilar cholangiocarcinoma; Klatskin tumor; Left hepatectomy; R0 resection; Right hepatectomy.

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Figures

Fig. 1
Fig. 1. Flowchart of patients.
Fig. 2
Fig. 2. Survival analysis for all patients. (A) Overall survival, (B) Disease-free survival.
Fig. 3
Fig. 3. Comparison of outcomes between IIIa and IIIb. (A) Overall survival, (B) Disease-free survival.
Fig. 4
Fig. 4. Comparison of outcomes between extended hepatectomy with caudate lobectomy and simple hepatectomy without caudate lobectomy. (A) Overall survival, (B) Disease-free survival.
Fig. 5
Fig. 5. Comparison of outcomes between R0 resection and R1 or R2 resection. (A) Overall survival, (B) disease-free survival.
See this image and copyright information in PMC

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