Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter?

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

doi:10.21037/hbsn-19-948

Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter?

Hepatobiliary Surg Nutr. 2021 Apr;10(2):154-162. doi: 10.21037/hbsn-19-948.

Authors

Lotte C Franken¹, Pim B Olthof^{1

2}, Joris I Erdmann¹, Otto M van Delden³, Joanne Verheij⁴, Marc G Besselink¹, Olivier R Busch¹, Thomas M van Gulik¹

Affiliations

¹ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands.
² Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
³ Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

Background: The only potentially curative option for patients with perihilar cholangiocarcinoma (PHC) is resection, typically an extrahepatic bile duct resection in combination with (extended) liver resection. Complications such as bile leakage and liver failure have been suggested to be more common after right-sided resections compared to left-sided resections, whilst superior oncological outcomes have been reported after right-sided resections. However, data on outcomes after right-sided or left-sided liver resections in PHC are scarce. Therefore, we aimed to investigate short- and long-term outcomes after left and right hemihepatectomy in patients with PHC.

Methods: In this retrospective study, patients undergoing major liver resection for suspected PHC in a tertiary center between 2000-2018 were included. Patients who had undergone left-sided resections were compared to patients with right-sided resections in terms of complications (90-day mortality, overall and severe morbidity and specific complications). For long-term outcomes, only patients with pathologically proven PHC were included in the survival analysis.

Results: A total of 178 patients undergoing hemihepatectomy for suspected PHC were analysed, including 76 left-sided and 102 right-sided resections. Overall 90-day mortality was 14% (24 out of 178), with no significant difference after left-sided resection (11%; 8 out of 76) versus right-sided resection (16%; 16 out of 102) (P=0.319). Severe morbidity (Clavein Dindo ≥3) was also comparable in both groups: 54% versus 61% (P=0.361). No differences in specific complications including bile leakage were observed, although liver failure appeared to occur more frequently after right hemihepatectomy (22% versus 11%, P=0.052). Five-year overall survival for pathologically proven PHC, excluding in-hospital mortality, did not differ; 43.7% after left-sided resection vs. and 38.2% after right-sided resection (P=0.553).

Conclusions: Both short- and long-term outcomes between patients undergoing left and right hemihepatectomy for PHC were comparable. Post-hepatectomy liver failure was more common after right-sided resection.

Keywords: Perihilar cholangiocarcinoma (PHC); hepatectomy; mortality; outcomes; survival.