Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible
Pim B. Olthof, Joris I. Erdmann, Ruslan Alikhanov, R. Charco, Alfredo Guglielmi, Jeroen Hagendoorn, Abdul Hakeem, Frederik J.H. Hoogwater, William R. Jarnagin, Geert Kazemier, Hauke Lang, Shishir K. Maithel, Massimo Malagó, Hassan Malik, Silvio Nadalin, Ulf P. Neumann, Steven W.M. Olde Damink, Johann Pratschke, Francesca Ratti, Matteo Ravaioli, Keith Roberts, Erik Schadde, Andreas A. Schnitzbauer, Ernesto Sparrelid, Baki Topal, Roberto Troisi, Bas Groot Koerkamp, Luca Aldrighetti, F. Bartsch, Wolf O. Bechstein, Jan Bednarsch, C. M. A. de BenzingBoer, Stefan A.W. Bouwense, Ivan Capobianco, Matteo Cescon, Michael I. D’Angelica, Maxime Dewulf, Philip de Reuver, E. de Savornin Lohman, Михаил Ефанов, Lotte C. Franken, Joachim Geers, Mariano Cesare Giglio, Stefan Gilg, Concepción Gómez‐Gavara, Thomas M. van Gulik, Jan Heil, Jan N.M. IJzermans, Hannes Jansson, T. Peter Kingham, P. Lodge, Rabea Margies, Rebecca Marino, Q. Molenaar, T. A. Nguyen, Lynn E. Nooijen, Carolijn L. Nota, Elena Poletto, R.J. Porte, R. Prasad, Leonard Quinn, Jens Rolinger, Andrea Ruzzenente, Moritz Schmelzle, Matteo Serenari, Anjuman Sultana, Stijn van Laarhoven, Babs M. Zonderhuis
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.