Isamu Hosokawa1, Hiroaki Shimizu2, Hideyuki Yoshitomi3, Katsunori Furukawa3, Tsukasa Takayashiki3, Satoshi Kuboki3, Keiji Koda2, Masaru Miyazaki4, Masayuki Ohtsuka5. 1. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. 2. Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. 3. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 4. Mita Hospital, International University of Health and Welfare, Tokyo, Japan. 5. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: otsuka-m@faculty.chiba-u.jp.
Abstract
BACKGROUND: Right hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC. METHODS: Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching. RESULTS: Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups. CONCLUSIONS: In patients with PHC, LT could achieve similar surgical and survival outcomes as RH.
BACKGROUND: Right hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC. METHODS: Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching. RESULTS: Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups. CONCLUSIONS: In patients with PHC, LT could achieve similar surgical and survival outcomes as RH.
Authors: Lotte C Franken; Pim B Olthof; Joris I Erdmann; Otto M van Delden; Joanne Verheij; Marc G Besselink; Olivier R Busch; Thomas M van Gulik Journal: Hepatobiliary Surg Nutr Date: 2021-04 Impact factor: 8.265