Treatment of resectable hilar cholangiocarcinoma: a choice of right- or left-side hepatectomy

Abstract

Introduction: Radical resection is the only curative treatment for patients with hilar cholangiocarcinoma. Some have argued that left-side hepatectomy has worse prognosis regarding its contiguous anatomical relationship between hepatic inflow and biliary confluence, otherwise right-side hepatectomy has worse surgical morbidity and mortality. This study aimed to compare the surgical morbidity and long-term outcome between right- and left-side hepatectomy to help the decision of which side to be resected in the surgical treatment of hilar cholangiocarcinoma. Method: A total of 83 patients attempting curative resection for hilar cholangiocarcinoma at the Korea University Medical Center between 2010 and 2017 were considered for this study. After excluding patients who did not undergo curative-intent surgery or hepatectomy, 57 patients undergoing right- or left-side hepatectomy were finally enrolled for analysis. Prospectively collected clinicopathologic characteristics, perioperative outcomes, and survival were evaluated. Result: Right-side hepatectomy (RH) and left-side hepatectomy (LH) were performed for 33 and 24 patients, respectively. The proportion of R0 resection was comparable between both groups (75.8% for RH group and 75.0% for LH group, p=0.948). Posthepatectomy liver failure was significantly more prevalent in the RH group than the LH group (75.7% vs. 12.5%, p<0.001). 90-day mortality did not differ between both groups (9.1% vs. 4.2%, p=0.631). The 5-year overall survival rate was 37.7% for the RH group; and 41.9% for the LH group (p=0.500). The 5-year recurrence-free survival rate was 26.3% for the RH group; and 33.9% for the LH group (p=0.580). Conclusion: Posthepatectomy liver failure was more prevalent in the RH group than the LH group, but it did not affect the 90-day mortality. It is recommended to perform surgical resection only according to the possibility to achieve radical resection, regardless of right- or left-side hepatectomy.