Extended left versus extended right hepatectomy with Hilar en-bloc resection in perihilar cholangiocarcinoma

Abstract

Background: Hilar en-bloc resection with portal vein resection (PVR) has emerged as the mainstay of treatment for patients with perihilar cholangiocarcinoma (PHCC). Whether liver resection should be carried out as extended left- (LH) or right-sided hepatectomy (RH) is still subject of ongoing debate. Here we evaluated perioperative complications and oncological outcome after RH or LH with hilar en-bloc resection and PVR in patients with PHCC. Methods: Between 2010 and 2016, 91 patients with PHCC underwent surgery in curative intent at our institution. Perioperative and survival data from all patients undergoing surgical resection for PHCC were analyzed. PVR was carried out in all cases as well as arterial reconstruction (n=5) if necessary. Patients undergoing hepatoduodenectomy (n=8) or ALPPS (n=2) were excluded from the analysis. Results: Tumor grading, microvascular invasion, lymphovascular invasion, N-category, T-category, R-status and UICC tumor staging were equally distributed among the LH (n=36) and RH (n=45) groups. Perioperative morbidity and mortality were higher after RH compared to LH (15.6% vs. 8.3%, p=0.003). While 3-year OS was comparable between LH and RH (55% vs. 48%), we observed a non-significant difference in 5-year OS with 18% and 43% for LH and RH respectively (p=0.820, log rank). Conclusions: LH and RH hilar en-bloc resections demonstrate comparable 3-year OS. While RH hilar en-bloc resection might result in better long-term 5-year survival, this may be at cost of an increase in perioperative morbidity and mortality.