Related Experiment Video
Updated: Oct 25, 2025
Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection
Published on: April 11, 2025
Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma
Insights
Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) shows comparable outcomes to non-VR procedures. This complex surgery is safe and effective in specialized centers, offering similar survival rates for selected patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Perihilar cholangiocarcinoma (PHCC) presents significant surgical challenges, particularly when requiring hepatectomy with vascular resection (VR).
- Limited published data exists on the clinical significance and outcomes of hepatectomy with VR for PHCC.
Purpose of the Study:
- To evaluate and compare the surgical outcomes of hepatectomy with vascular resection (VR) versus non-VR in patients with perihilar cholangiocarcinoma (PHCC).
- To assess the safety and efficacy of complex hepatectomy procedures for PHCC.
Main Methods:
- A retrospective study of 238 patients undergoing surgical resection for PHCC between 2002 and 2017.
- Comparison of surgical outcomes, including morbidity, mortality, and survival rates, between patients who underwent VR (n=85) and those who did not (non-VR, n=153).
- Analysis stratified by preoperative imaging and carbohydrate antigen 19-9 (CA19-9) levels.
Main Results:
- Morbidity (49.4% vs 43.8%) and mortality (3.5% vs 3.3%) rates were comparable between the VR and non-VR groups.
- Median survival time (MST) was 36 months for the VR group and 45 months for the non-VR group (P=0.124).
- In patients with suspected tumor involvement and CA19-9 ≤ 37 U/mL, VR group showed significantly longer MST (50 vs 34 months, P=0.017); this difference was not observed when CA19-9 > 37 U/mL (28 vs 29 months, P=0.520).
Conclusions:
- Hepatectomy with vascular resection (VR) for PHCC can be safely performed in highly specialized hepatobiliary centers.
- The procedure demonstrates equivalent short-term (morbidity, mortality) and long-term (survival) outcomes compared to hepatectomy without VR in carefully selected patients.
- Outcomes are influenced by preoperative tumor characteristics, including CA19-9 levels, suggesting patient selection is crucial for optimal results.
Background:
Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) is a challenging procedure. However, only a few reports on this procedure have been published and its clinical significance has not been fully evaluated.
Methods:
Patients undergoing surgical resection for PHCC from 2002-2017 were studied. The surgical outcomes of VR and non-VR groups were compared.
Results:
Some 238 patients were included. VR was performed in 85 patients. The resected vessels were hepatic artery alone (31 patients), portal vein alone (37 patients) or both (17 patients). The morbidity rates were almost the same in the VR (49.4 per cent) and non-VR (43.8 per cent) groups (P = 0.404). The mortality rates of VR (3.5 per cent) and non-VR (3.3 per cent) were also comparable (P > 0.999). The median survival time (MST) was 45 months in the non-VR group and 36 months in VR group (P = 0.124). Among patients in whom tumour involvement was suspected on preoperative imaging and whose carbohydrate antigen 19-9 (CA19-9) value was 37 U/ml or less, MST in the VR group was significantly longer than that in the non-VR group (50 versus 34 months, P = 0.017). In contrast, when the CA19-9 value was greater than 37 U/ml, MST of the VR and non-VR groups was comparable (28 versus 29 months, P = 0.520).
Conclusion:
Hepatectomy with VR for PHCC can be performed in a highly specialized hepatobiliary centre with equivalent short- and long-term outcomes to hepatectomy without VR.
