Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Perihilar cholangiocarcinoma (pCCA) treatment often involves liver resection.
• Surgical approach (right vs. left-sided resection) depends on tumor location and vascular involvement.
• Outcomes of different liver resection sides for pCCA require comparative analysis.

Purpose of the Study:

• To compare postoperative mortality and long-term survival.
• To evaluate right- versus left-sided liver resections for pCCA.
• To identify prognostic factors in pCCA liver resections.

Main Methods:

• Retrospective analysis of 1701 patients undergoing major liver resection for pCCA across 25 Western centers (2000-2022).
• Patients stratified by hepatectomy type: left, extended left, right, and extended right.
• Primary outcomes: 90-day mortality and overall survival (OS).

Main Results:

• 90-day mortality was 9% for left-sided and 18% for right-sided resections (p < 0.001).
• Median OS was 30 months for left-sided and 23 months for right-sided resections (p < 0.001).
• Left-sided resection was an independent favorable prognostic factor for 90-day mortality and OS.

Conclusions:

• Left or extended left hepatectomy is linked to lower 90-day mortality and superior OS compared to right-sided hepatectomy for pCCA.
• Left-sided liver resection is preferred when both right and left options are feasible for pCCA.
• Surgical side choice significantly impacts pCCA patient outcomes.