Surgical outcomes of left trisectionectomy combined with vascular reconstruction for perihilar cholangiocarcinoma

Abstract

Introduction: Left risectionectomy for perihilar cholangiocarcinoma (PHC) is a complicated and extensive surgical procedure with high morbidity and mortality rates. Hence thorough regional extirpation including combined resection of adjacent vasculature is often required for curative surgical treatment of PHC. In the present study, we elucidate whether left trisectionectomy is efficacious in surgery for PHC. Method: Between April 1992 and December 2017, our department surgically treated 252 cases of PHC. These included 19 cases for which we performed left trisectionectomy (Tri) and 71 cases that underwent left hemihepatectomy (Hemi). Curative resection rates, incidences of Clavien-Dindo grade III or higher complications, in-hospital mortality rates, and long-term results were analyzed. Result: Preoperative patients’ background of the two group is almost similar except Bismuth type (Bismuth type IV; 94.7% in Tri, 22.5% in Hemi, p<0.001). Although PD was added 11.2% (8/71) in Hemi and only one patient in Tri (5.2%: 1/19) (p=0.730). Hepatic artery reconstruction was performed 39.4% (28/71) in Hemi and 73.6% (14/19) in Tri (p=0.007). Curative resection rates were almost same in both groups: 73.6% (14/19) in Tri and 80.2% (57/71) in Hemi (p=0.531). No Tri cases showed a positive bile duct surgical margin. Incidences of complications were similar in both groups, at 73.6% in Tri, and 54.9% in Hemi (p=0.140). In-hospital mortality rates in Tri were statistically higher than those in Hemi (26.3% (5/19) vs 8.4% (6/71), p=0.034). Five-year survival rates were 30.1% in Tri and 34.9% in Hemi. In Tri, the resection afforded good long-term results even with advanced cancers. Conclusion: Left trisectionectomy proved useful in securing the bile duct margin. However, as left trisectionectomy remains a challenging procedure with high in-hospital mortality rates, surgeons need to pay close attention to anatomical variations in order to perform left trisectionectomy safely and successfully.