Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible
Year: 2024
Type: article
Study design: Observational Study
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.
Source: Annals of Surgical Oncology
Authors: Pim B. Olthof, Joris I. Erdmann, Ruslan Alikhanov, Ramón Charco, Alfredo Guglielmi, Jeroen Hagendoorn, Abdul Hakeem, Frederik J. H. Hoogwater, William R. Jarnagin, Geert Kazemier, Hauke Lang, Shishir K. Maithel, Massimo Malago, Hassan Z. Malik, Silvio Nadalin, Ulf Neumann, Steven W. M. Olde Damink, Johann Pratschke, Francesca Ratti, Matteo Ravaioli, Keith J. Roberts, Erik Schadde, Andreas A. Schnitzbauer, Ernesto Sparrelid, Baki Topal, Roberto I. Troisi, Bas Groot Koerkamp, L. Aldrighetti, F. Bartsch, W. O. Bechstein, J. Bednarsch, C. M. A. de BenzingBoer, S. A. Bouwense, I. Capobianco, M. Cescon, M. I. D’Angelica, M. Dewulf, P. de Reuver, E. de Savornin Lohman, M. Efanov, L. C. Franken, J. Geers, M. C. Giglio, S. Gilg, C. Gomez-Gavara, T. M. van Gulik, J. Heil, J. N. M. IJzermans, H. Jansson, T. P. Kingham, P. Lodge, R. Margies, R. Marino, Q. I. Molenaar, T. A. Nguyen, L. E. Nooijen, C. L. M. Nota, E. Poletto, R. J. Porte, R. Prasad, L. M. Quinn, J. Rolinger, A. Ruzzenente, M. Schmelzle, M. Serenari, A. Sultana, S. van Laarhoven, B. M. Zonderhuis
Institutions: University Medical Center Groningen, Erasmus MC, Amsterdam University Medical Centers, Moscow Clinical Scientific Center, Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, University of Verona, Utrecht University, University Medical Center Utrecht, St James's University Hospital, Memorial Sloan Kettering Cancer Center, University Medical Center of the Johannes Gutenberg University Mainz, Emory University, Winship Cancer Institute, The Royal Free Hospital, University College London, Aintree University Hospital, Universitätsklinikum Tübingen, University of Tübingen, Universitätsklinikum Aachen, RWTH Aachen University, Maastricht University Medical Centre, Maastricht University, Charité - Universitätsmedizin Berlin, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University Hospitals Birmingham NHS Foundation Trust, Rush University Medical Center, University Hospital Frankfurt, Karolinska University Hospital, Karolinska Institutet, KU Leuven, Federico II University Hospital, University of Naples Federico II
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
Funder: National Cancer Institute
Award: Cancer Center Support Grant
OpenAlex ID: W4392682175