Ann Surg Treat Res.  2020 Jan;98(1):15-22. 10.4174/astr.2020.98.1.15.

Comparison study for surgical outcomes of right versus left side hemihepatectomy to treat hilar cholangiocellular carcinoma

• Hong SS
• Han DH
• Choi GH
• Choi JS

• KMID: 2466559
• DOI: http://doi.org/10.4174/astr.2020.98.1.15

Abstract

PURPOSE
Major liver resection and radical lymph node dissection has been accepted as a definite treatment of choice for hilar cholangiocarcinoma (HC). However, the perioperative and survival outcomes of right hemihepatectomy (RH) and left hemihepatectomy (LH) still remain controversial. Thus, this study aimed to compare the surgical and oncological outcomes of RH and LH in HC patients.
METHODS
From January 2000 to January 2018, a total of 326 patients underwent surgical resection for HC at Yonsei University College of Medicine in Seoul, Korea. Among the 326 patients, we excluded 130 patients and selected 196 patients, who underwent hemihepatectomy with caudate lobectomy. Among these 196 patients, 114 patients underwent RH, and 82 patients underwent LH. We compared the clinicopathological features as well as the surgical and oncologic outcomes of the RH and LH groups.
RESULTS
There were no significant differences in disease-free survival (P = 0.473) or overall survival (P = 0.946) in the RH and LH groups. The LH group had fewer complications compared with the RH group, including postoperative ascites (RH: 15 [13.2%] vs. LH: 3 [3.7%], P = 0.023); however, the LH group had more bile leakage complications (RH: 5 [4.4%] vs. LH: 12 [14.6%], P = 0.012). The average time lag from portal vein embolization to operation was 25.80 ± 12.06 days (n = 45). There was no difference in postoperative liver failure (P = 0.402), although there were significantly more frequent ascites after RH (P = 0.023).
CONCLUSION
LH might be a good alternative option for the surgical treatment of HC given appropriate tumor location and biliary anatomy indications.

Keyword

Hepatectomy; Klatskin tumor; Treatment outcome

MeSH Terms

Ascites
Bile
Cholangiocarcinoma*
Disease-Free Survival
Hepatectomy
Humans
Klatskin Tumor
Korea
Liver
Liver Failure
Lymph Node Excision
Portal Vein
Seoul
Treatment Outcome

Figure

• 

  Fig. 1 Classification of patients for the study. Among 326 total patients diagnosed as hilar cholangiocarcinoma (HC), 130 patients were excluded; the remaining patients were then divided into 2 groups of right hemihepatectomy (RH) patients (n = 114) and left hemihepatectomy (LH) patients (n = 82). In one subgroup analysis, we compared RH patients of Bismuth type II or type IV (n = 35) and LH patients, and in another subgroup analysis, we also compared patients who underwent portal vein embolization (PVE) followed by RH (n = 45) and LH (n = 82) patients.

• 

  Fig. 2 (A, B) Disease-free and overall survival rates in RH vs. LH groups. In subgroup analysis, disease-free and overall survival rates in RH of Bismuth type II or IV patients and in LH patients (C, D), and in PVE + RH and LH patients (E, F). PVE, portal vein embolization; RH, right hemihepatectomy; LH, left hemihepatectomy.

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