Comparison analysis of left – versus right-sided resection in bismuth type III Hilar cholangiocarcinoma

Abstract

Introduction: Several studies reported worse prognosis after left-sided liver resection than right in patients with perihilar cholangiocarcinoma(CCC). We compared outcomes of left- and right-sided resections in Bismuth type III hilar cholangiocarcinoma and analyzed factors affecting survival. Method: From May 1995 to December 2011, a total of 179 patients underwent surgery for type III hilar CCC in Samsung Medical Center. Among them, 138 patients received hepatectomies for adenocarcinoma with curative intent. 103 patients underwent right-sided resections (IIIa group), whereas 35 patients underwent left-sided resections (IIIb group). Perioperative demographics, morbidity, mortality, and overall and disease-free survival rates were compared between the groups. Results: BMI was higher in IIIa group (24±2.6kg/m2 vs 22.7±2.8kg/m2; p=0.012). Preoperative portal vein embolization was done in 23.3% of patients in IIIa group, whereas none in IIIb group. The R0 rate was 82.5% in the IIIa group and 85.7% in the IIIb group (p=0.796). 3a complication of Clavien-Dindo classification showed significant difference in between the two groups (10.7% in the IIIa group versus 23.3% in the IIIb group; 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 stage 3 and 4 and LN metastasis were independent prognostic factors for survival and recurrence by multivariate analysis. Conclusions: There was no significant difference in outcomes according to lesion side in patients with Bismuth type III hilar CCC after curative surgery.