Concomitant hepatic artery resection for advanced perihilar cholangiocarcinoma: a case-control study with propensity score matching.

Abstract

Whether concomitant hepatic artery resection (HAR) improves the prognosis for advanced perihilar cholangiocarcinoma remains controversial. The aim of the present study was to compare short- and long-term surgical results of HAR versus standard resection (SR) for perihilar cholangiocarcinoma using propensity score matching. Among 209 patients with perihilar cholangiocarcinoma patients who underwent resection in our department, 28 patients underwent HAR, and the remaining 181 patients underwent SR. To adjust for differences in clinicopathological factors, including difficulty in surgery, between groups, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 24 patients per group. The study protocols were approved by our institutional review board (015-0365), enrolled in UMIN-CTR (No: UMIN000019927), and conducted according to the Declaration of Helsinki. No significant differences were seen in overall incidence of postoperative complications (Clavien-Dindo classification ≥IIIa: 37.5% in SR group vs. 62.5% in HAR group; P=0.080), except for postoperative liver abscess formation (P=0.020). Five-year overall survival rates were 30.3% and 20.4%, respectively. No significant difference in overall survival rate was apparent between the SR and HAR groups (P=0.150). Despite being a demanding procedure, concomitant HAR appears feasible for selected patients with perihilar cholangiocarcinoma.