Outcomes of liver resection for hilar cholangiocarcinoma of bismuth type III and IV: a minor versus major approach

Abstract

Background: Combined liver resection for hilar cholangiocarcinoma (HCCA) of Bismuth type III and IV is now adopted by most surgeons. However, the optimal extent of hepatic resection to achieve negative margin still remains controversial. Methods: Between March 2006 and March 2016, 78 consecutive patients with Bismuth type III and IV HCCA underwent surgical resection with curative intent. Patients were classified into two groups: minor liver resection group (n = 46) and major liver resection group B (n = 32). The preioperative outcomes and long-term outcomes including overall or disease-free survival rate were compared. Results: The major liver resection group had significantly higher R0 resection rates compared with the minor liver resection group (84.4% versus 60.1%, p = 0.025), albeit with higher blood transfusion requirements (62.5% versus 23.9%, p < 0.001) and longer length hospital stay (26.75 ± 10.29 versus 20.48±6.90, p = 0.002). Comparing with minor liver resection, major liver resection resulted in significantly higher general complications (34% versus 13%, p = 0.025), but it showed better overall survival (OS) (p = 0.006) and disease-free survival (p = 0.041). Conclusion: Major liver resection, after biliary drainage and preoperative portal vein embolization, when necessary, should be considered in patients with Bismuth type III and IV HCCA.