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KMID : 1143920180220040350
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Annals of Hepato-Biliary-Pancreatic Surgery
2018 Volume.22 No. 4 p.350 ~ p.358
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Comparison analysis of left-side versus right-side resection in bismuth type III hilar cholangiocarcinoma
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Lee You-Jin
Choi Dong-Wook
Han Sun-Jong
Han In-Woong
Heo Jin-Seok
Choi Seong-Ho
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Abstract
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Backgrounds/Aims: Several studies report worse prognosis after left-side compared to right-side liver resection in patients with perihilar cholangiocarcinoma. In this study, we compared outcomes of left-side and right-side resections for Bismuth type III hilar cholangiocarcinoma and analyzed factors affecting survival.
Methods: From May 1995 to December 2012, 179 patients underwent surgery at Samsung Medical Center for type III hilar cholangiocarcinoma. Among these patients, 138 received hepatectomies for adenocarcinoma with curative intent: 103 had right-side resections (IIIa group) and 35 had left-side resections (IIIb group). Perioperative demographics, morbidity, mortality, and overall and disease-free survival rates were compared between the groups.
Results: BMI was higher in the IIIa group (24±2.6 kg/m2 versus 22.7±2.8 kg/m2; p=0.012). Preoperative portal vein embolization was done in 23.3% of patients in the IIIa group and none in the IIIb group. R0 rate was 82.5% in the IIIa group and 85.7% in the IIIb group (p=0.796) and 3a complications by Clavien-Dindo classification were significantly different between groups (10.7% for IIIa versus 23.3% for IIIb; p=0.002). The 5-year overall survival rate was 33% in the IIIa group and 35% in the IIIb group (p=0.983). The 5-year disease-free survival rate was 28% in the IIIa group and 29% in the IIIb group (p=0.706). Advanced T-stages 3 and 4 and LN metastasis were independent prognostic factors for survival and recurrence by multivariate analysis.
Conclusions: No significant differences were seen in outcomes by lesion side in patients receiving curative surgery for Bismuth type III hilar cholangiocarcinoma.
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KEYWORD
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Hilar cholangiocarcinoma, Klatskin tumor, R0 resection, Right hepatectomy, Left hepatectomy
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