Abstract
Hilar cholangiocarcinoma (HCCA) arises from the confluence of the common hepatic duct and has a poor prognosis. If resectable, an extended left (eLH) or right hemihepatectomy (eRH) is usually required to provide oncological clearance. We reviewed outcomes for patients with HCCA managed at our centre. Electronic records of patients referred to our centre for HCCA were retrospectively reviewed. The Kaplan–Meier method was used to estimate overall survival (OS) with the log rank test used for significance (p 0.05). Patients undergoing an eLH for HCCA have significantly better long-term outcomes compared to those undergoing eRH, independent of other pathological variables. The functional liver remnant (FLR) is usually smaller following eRH, resulting in a higher risk of post-operative liver failure. Combining CT volumetry with PVE may result in better prediction and optimisation of the FLR in the context of eRH for HCCA. An extended left hemihepatectomy is an independent predictor of survival; investigation into the precise interaction between left- and right-sided resections and pre- and post-embolization liver volume is warranted.
Highlights
Hilar cholangiocarcinoma (HCCA) is a malignant tumour arising from the confluence of the common hepatic duct into left and right branches
Resectable HCCA often requires an extended hemihepatectomy with en bloc resection of the caudate lobe to provide oncologic clearance of the tumour, which is associated with a significant mortality risk secondary to post-operative liver failure (PLF)
A total of 156 patients with confirmed HCCA were managed at our centre
Summary
Hilar cholangiocarcinoma (HCCA) is a malignant tumour arising from the confluence of the common hepatic duct into left and right branches. HCCA has a poor prognosis, often due to locally advanced disease precluding curative treatment; patients with unresectable disease are known to have shorter survival compared to patients undergoing resection [2, 4, 5]. Operative and non-operative management of HCCA in both the curative and palliative settings is associated with significant risks of morbidity and mortality [1, 2]. Resectable HCCA often requires an extended hemihepatectomy with en bloc resection of the caudate lobe to provide oncologic clearance of the tumour, which is associated with a significant mortality risk secondary to post-operative liver failure (PLF). Ipsilateral portal vein embolisation (PVE) improves operative outcomes for extended resections by inducing hypertrophy in the contralateral remnant liver pre-operatively, thereby reducing the risk of PLF [7, 8]. An extended right hemihepatectomy [10] results in a smaller functional liver remnant (FLR) compared to an extended left hemihepatectomy (eLH), resulting in a significantly greater risk of PLF
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