Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Mar 4;9(2):zraf019.
doi: 10.1093/bjsopen/zraf019.

Western and Eastern experience in treating perihilar cholangiocarcinoma: retrospective bi-centre study

Hannes Jansson  1   2 , Atsushi Oba  2 , Aya Maekawa  2 , Christina Villard  3 , Kosuke Kobayashi  2 , Yoshihiro Ono  2 , Jennie Engstrand  1 , Fumihiro Kawano  2 , Hiromichi Ito  2 , Stefan Gilg  1 , Yosuke Inoue  2 , Melroy A D'Souza  1 , Yu Takahashi  2
Affiliations
Comparative Study

Western and Eastern experience in treating perihilar cholangiocarcinoma: retrospective bi-centre study

Hannes Jansson et al. BJS Open. .

Abstract

Background: Resection outcomes for perihilar cholangiocarcinoma differ between Western and Eastern centres, but reasons behind these disparities remain unclear. This study aimed to compare current outcomes between a Western and an Eastern expert centre to identify prognostic factors.

Methods: Patients who underwent hepatobiliary resection for perihilar cholangiocarcinoma between 2010 and 2022 at Karolinska University Hospital (Stockholm, Sweden) and Cancer Institute Hospital (Tokyo, Japan) were retrospectively included. Primary outcome was overall survival. Secondary outcomes were disease-free survival, postoperative complications and 90-day mortality rate.

Results: Two hundred and forty-nine patients were included (Cancer Institute Hospital n = 159, Karolinska n = 90). Median overall survival was 20.4 months at Karolinska and 52.0 months at Cancer Institute Hospital (P < 0.001). Median disease-free survival was 11.9 months at Karolinska and 32.4 months at Cancer Institute Hospital (P < 0.001). Advanced tumours, ASA class ≥III, poor differentiation and radial margin positivity were more common in the Western cohort. Treatment centre, T-status, N1-status, resection side, R1-status, age and carbohydrate antigen 19-9 were prognostic for overall survival. The Eastern cohort had a lower rate of postoperative complications (24.5%) and a lower mortality rate (2.5%) compared with the Western cohort (51.1% and 10.0%).

Conclusion: Advanced tumour stage and radial margin positivity contributed to poor long-term survival in the Western cohort. A higher burden of co-morbidity and a higher rate of extended resections with smaller remnant liver volume influenced the Western postoperative mortality rate.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a Overall survival and b disease-free survival after resection for pCCA with stratification according to centre CIH, Cancer Institute Hospital; Kar, Karolinska University Hospital; pCCA, perihilar cholangiocarcinoma.
Fig. 2
Fig. 2
Overall survival after resection for pCCA according to tumour extension and lymph node status a T1–T2a N0, b T1–T2a N1, c T2b N0, d T2b N1, e T3–T4 N0, f T3–T4 N1. CIH, Cancer Institute Hospital; Kar, Karolinska University Hospital; N0/N1, absence/presence of lymph node metastasis; pCCA, perihilar cholangiocarcinoma; T, tumour extension status.
See this image and copyright information in PMC

References

    1. Mueller M, Breuer E, Mizuno T, Bartsch F, Ratti F, Benzing C et al. Perihilar cholangiocarcinoma—novel benchmark values for surgical and oncological outcomes from 24 expert centers. Ann Surg 2021;274:780–788 - PubMed
    1. Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013;258:129–140 - PubMed
    1. Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo S, Nagino M et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg 2000;232:166–174 - PMC - PubMed
    1. Olthof PB, Aldrighetti L, Alikhanov R, Cescon M, Koerkamp G, Jarnagin B et al. Portal vein embolization is associated with reduced liver failure and mortality in high-risk resections for perihilar cholangiocarcinoma. Ann Surg Oncol 2020;27:2311–2318 - PMC - PubMed
    1. Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y et al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 1995;117:677–681 - PubMed

MeSH terms