Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible Journal Article
| Authors: | Olthof, P. B.; Erdmann, J. I.; Alikhanov, R.; Charco, R.; Guglielmi, A.; Hagendoorn, J.; Hakeem, A.; Hoogwater, F. J. H.; Jarnagin, W. R.; Kazemier, G.; Lang, H.; Maithel, S. K.; Malago, M.; Malik, H. Z.; Nadalin, S.; Neumann, U.; Damink, Swmo; Pratschke, J.; Ratti, F.; Ravaioli, M.; Roberts, K. J.; Schadde, E.; Schnitzbauer, A. A.; Sparrelid, E.; Topal, B.; Troisi, R. I.; Koerkamp, B. G. |
| Article Title: | Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible |
| Abstract: | BackgroundA 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. MethodsPatients 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). ResultsBetween 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. ConclusionsA 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. |
| Keywords: | surgery; biliary drainage; failure; portal-vein; hemihepatectomy; risk score |
| Journal Title: | Annals of Surgical Oncology |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Publication status: | Online ahead of print |
| Date Published: | 2024-01-01 |
| Online Publication Date: | 2024-01-01 |
| Language: | English |
| ACCESSION: | WOS:001182017300006 |
| DOI: | 10.1245/s10434-024-15115-0 |
| PROVIDER: | wos |
| PMCID: | PMC11164810 |
| PUBMED: | 38472674 |
| Notes: | Article; Early Access -- Source: Wos |
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