Outcomes of left trisectionectomy and right hepatectomy for perihilar cholangiocarcinoma

Abstract

Background: Right hepatectomy (RH) is a standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. The aim of this study was to compare the outcomes of LT vs. RH for PHC. Methods: Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching. The primary end points of the study were major complications (Clavien-Dindo grades III-IV), 90-day mortality, R0 resection, recurrence-free survival (RFS) and overall survival (OS). Results: Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (36.9%) underwent LT, and 70 (63.1%) underwent RH. In a matched cohort (LT; n=27, RH; n=27), major complication rates (67% vs. 52%; p=0.42), 90-day mortality rates (15% vs. 0%; p=0.11) and R0 resection rates (56% vs. 44%; p=0.58) were similar in both groups. The 3-year RFS rates (27% vs. 47%; p=0.27) and OS rates (45% vs. 60%; p=0.17) were similar in both groups. On multivariate analysis, CA19-9 ≤145 U/mL, initially resectable disease, and a histological tumor grade of G1 were identified as independent predictors of a favorable prognosis in patients who underwent LT and RH for PHC. Conclusions: In patients with PHC, LT could achieve similar surgical and survival outcomes as RH.