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Annals of Surgical Oncology

Open Access 12-03-2024 | Liver Resection | Hepatobiliary Tumors

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Authors: Pim B. Olthof, MD, PhD, Joris I. Erdmann, MD, PhD, Ruslan Alikhanov, MD, PhD, Ramón Charco, MD, PhD, Alfredo Guglielmi, MD, PhD, Jeroen Hagendoorn, MD, PhD, Abdul Hakeem, MD, PhD, Frederik J. H. Hoogwater, MD, PhD, William R. Jarnagin, MD, PhD, Geert Kazemier, MD, PhD, Hauke Lang, MD, PhD, Shishir K. Maithel, MD, PhD, FACS, Massimo Malago, MD, PhD, Hassan Z. Malik, MD, PhD, Silvio Nadalin, MD, PhD, Ulf Neumann, MD, PhD, Steven W. M. Olde Damink, MD, PhD, Johann Pratschke, MD, PhD, Francesca Ratti, MD, PhD, Matteo Ravaioli, MD, PhD, Keith J. Roberts, MD, PhD, Erik Schadde, MD, Andreas A. Schnitzbauer, MD, PhD, Ernesto Sparrelid, MD, PhD, Baki Topal, MD, PhD, Roberto I. Troisi, MD, PhD, Bas Groot Koerkamp, MD, PhD, Perihilar Cholangiocarcinoma Collaboration Group

Published in: Annals of Surgical Oncology

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Abstract

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.
Appendix
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Metadata
Title
Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible
Authors
Pim B. Olthof, MD, PhD
Joris I. Erdmann, MD, PhD
Ruslan Alikhanov, MD, PhD
Ramón Charco, MD, PhD
Alfredo Guglielmi, MD, PhD
Jeroen Hagendoorn, MD, PhD
Abdul Hakeem, MD, PhD
Frederik J. H. Hoogwater, MD, PhD
William R. Jarnagin, MD, PhD
Geert Kazemier, MD, PhD
Hauke Lang, MD, PhD
Shishir K. Maithel, MD, PhD, FACS
Massimo Malago, MD, PhD
Hassan Z. Malik, MD, PhD
Silvio Nadalin, MD, PhD
Ulf Neumann, MD, PhD
Steven W. M. Olde Damink, MD, PhD
Johann Pratschke, MD, PhD
Francesca Ratti, MD, PhD
Matteo Ravaioli, MD, PhD
Keith J. Roberts, MD, PhD
Erik Schadde, MD
Andreas A. Schnitzbauer, MD, PhD
Ernesto Sparrelid, MD, PhD
Baki Topal, MD, PhD
Roberto I. Troisi, MD, PhD
Bas Groot Koerkamp, MD, PhD
Perihilar Cholangiocarcinoma Collaboration Group
Publication date
12-03-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15115-0