Perihilar cholangiocarcinoma with and without portal vein and hepatic artery resection: Comparative analysis of early and late outcomes

Abstract

Background: Surgical resection is the only radical of curative-intent therapy for patients with perihilar cholangiocarcinoma (PHC). In this study, we compared the early and long-term outcomes in Moscow Clinical Scientific Center(MCSC) after resection for PHC with and without portal and hepatic artery resection. Patients and Methods: From December 2013 to December 2018 in MCSC was performed 100 radical hepatic resections for PHC. Since January 2015 (82 patients) the more aggressive approaches (en bloc liver resection, portal vein resection(PVR) and hepatic artery resection(HAR)) was indroduced if necessary for a complete removal of the tumor. The data of 30 patients with vascular resection (group A) were compared with those of 62 patients with a curative-intent surgery for PHC without vascular resection (group B). Perioperative morbidity, mortality, R0 rate and overall survival rate were compared between the groups. Results: 19 patients (23,1%) underwent PVR alone and 11 patients (13,4%) underwent HAR either with (n = 5) or without PVR (n = 6). R0 rate was 90 % in the group A and 87,7% in the group B (p>0.05). III-IV complications by Clavien-Dindo classification were significantly different between groups (66,7% for group A versus 45% for group B; (p<0,05). No differences between the groups were observed regarding the postoperative mortality rates(13,3% in the group A and 12,9% in the group B). The 3-year overall survival rate was 30% in the group A and 40% in the group B (p>0,05). Conclusion: No significant differences were seen in mortality and late outcomes by involving en bloc liver combined with vascular resection. An aggressive approach provides high R0 rates that increase resectability of PHC.