TY - JOUR
T1 - Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma
T2 - Left-Sided Resection is Preferred When Possible
AU - Olthof, Pim B
AU - Erdmann, Joris I
AU - Alikhanov, Ruslan
AU - Charco, Ramón
AU - Guglielmi, Alfredo
AU - Hagendoorn, Jeroen
AU - Hakeem, Abdul
AU - Hoogwater, Frederik J H
AU - Jarnagin, William R
AU - Kazemier, Geert
AU - Lang, Hauke
AU - Maithel, Shishir K
AU - Malago, Massimo
AU - Malik, Hassan Z
AU - Nadalin, Silvio
AU - Neumann, Ulf
AU - Olde Damink, Steven W M
AU - Pratschke, Johann
AU - Ratti, Francesca
AU - Ravaioli, Matteo
AU - Roberts, Keith J
AU - Schadde, Erik
AU - Schnitzbauer, Andreas A
AU - Sparrelid, Ernesto
AU - Topal, Baki
AU - Troisi, Roberto I
AU - Groot Koerkamp, Bas
AU - Perihilar Cholangiocarcinoma Collaboration Group
PY - 2024/3/12
Y1 - 2024/3/12
N2 - BACKGROUND: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. METHODS: Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). RESULTS: Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27-34) after left and 23 months (95% CI 20-25) after right liver resection (p < 0.001), and 33 months (95% CI 28-38), 27 months (95% CI 23-32), 25 months (95% CI 21-30), and 21 months (95% CI 18-24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. CONCLUSIONS: A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.
AB - BACKGROUND: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. METHODS: Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). RESULTS: Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27-34) after left and 23 months (95% CI 20-25) after right liver resection (p < 0.001), and 33 months (95% CI 28-38), 27 months (95% CI 23-32), 25 months (95% CI 21-30), and 21 months (95% CI 18-24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. CONCLUSIONS: A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.
U2 - 10.1245/s10434-024-15115-0
DO - 10.1245/s10434-024-15115-0
M3 - Article
SN - 1068-9265
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
ER -