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. 2024 Jul;31(7):4405-4412.
doi: 10.1245/s10434-024-15115-0. Epub 2024 Mar 12.

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Pim B Olthof  1   2   3 , Joris I Erdmann  4 , Ruslan Alikhanov  5 , Ramón Charco  6 , Alfredo Guglielmi  7 , Jeroen Hagendoorn  8 , Abdul Hakeem  9 , Frederik J H Hoogwater  10 , William R Jarnagin  11 , Geert Kazemier  4 , Hauke Lang  12 , Shishir K Maithel  13 , Massimo Malago  14 , Hassan Z Malik  15 , Silvio Nadalin  16 , Ulf Neumann  17 , Steven W M Olde Damink  18 , Johann Pratschke  19 , Francesca Ratti  20 , Matteo Ravaioli  21 , Keith J Roberts  22 , Erik Schadde  23 , Andreas A Schnitzbauer  24 , Ernesto Sparrelid  25 , Baki Topal  26 , Roberto I Troisi  27 , Bas Groot Koerkamp  28 ; Perihilar Cholangiocarcinoma Collaboration Group
Collaborators, Affiliations

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Pim B Olthof et al. Ann Surg Oncol. 2024 Jul.

Abstract

Background: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA.

Methods: Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS).

Results: Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27-34) after left and 23 months (95% CI 20-25) after right liver resection (p < 0.001), and 33 months (95% CI 28-38), 27 months (95% CI 23-32), 25 months (95% CI 21-30), and 21 months (95% CI 18-24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities.

Conclusions: A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.

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Figures

Fig. 1
Fig. 1
Overall survival of patients who underwent major liver resection for perihilar cholangiocarcinoma according to the type of hepatectomy
Fig. 2
Fig. 2
Overall survival after resection for Bismuth type A I/II and B IV perihilar cholangiocarcinoma according to the type of hepatectomy. Differences were tested using log-rank tests, and the numbers of patients at risk are shown below the graph
See this image and copyright information in PMC

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