Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma

• Published in: British journal of surgery Vol. 100; no. 6; pp. 801 - 807
• Main Authors: Esaki, M., Shimada, K., Nara, S., Kishi, Y., Sakamoto, Y., Kosuge, T., Sano, T.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-05-2013; Oxford University Press
• Subjects: Aged; Aged, 80 and over; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - surgery; Cholangiocarcinoma - mortality; Cholangiocarcinoma - surgery; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local - etiology; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9099

Background
Data on outcomes of left hepatic trisectionectomy (LT) for perihilar cholangiocarcinoma are limited. The aim of this study was to clarify short‐ and long‐term outcomes of LT for perihilar cholangiocarcinoma.
Methods
Patients with perihilar cholangiocarcinoma who underwent LT between January 2000 and October 2011 were analysed. Surgical variables, mortality, morbidity (Clavien grade I–V), recurrence sites and survival were compared between subjects who underwent LT, right hemihepatectomy or left hemihepatectomy.
Results
A total 214 patients underwent resection for perihilar cholangiocarcinoma, 25 (11·7 per cent) of whom underwent LT, 88 (41·1 per cent) right hemihepatectomy and 94 (43·9 per cent) left hepatectomy. There were no deaths among those who had LT, but 20 patients developed complications. The incidence of grade IIIa complications was significantly higher among patients who underwent LT than in patients who had right or left hemihepatectomy (P = 0·001 and P < 0·001 respectively). Only one patient developed a grade IIIb or IV complication (liver failure) after LT. The overall 5‐year survival rate after LT was 39 per cent and median survival was 45 months. There were no significant differences in survival between patients who underwent LT and those who had a right or left hemihepatectomy.
Conclusion
LT may provide a good outcome for advanced perihilar cholangiocarcinoma.
Alternative solution in selected cases