Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy?
How the side of an extended liver resection impacts the postoperative prognosis of advanced perihilar cholangiocarcinoma (PHC) is still controversial. We compared the outcomes of right (RTS) and left trisectionectomies (LTS) in Bismuth-Corlette (BC) type IV PHC resection. All patients undergoing RTS...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-06-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/11/2791 |
| _version_ | 1797493876078936064 |
|---|---|
| author | Heithem Jeddou Stylianos Tzedakis Francesco Orlando Antoine Robert Eric Meneyrol Damien Bergeat Fabien Robin Laurent Sulpice Karim Boudjema |
| author_facet | Heithem Jeddou Stylianos Tzedakis Francesco Orlando Antoine Robert Eric Meneyrol Damien Bergeat Fabien Robin Laurent Sulpice Karim Boudjema |
| author_sort | Heithem Jeddou |
| collection | DOAJ |
| description | How the side of an extended liver resection impacts the postoperative prognosis of advanced perihilar cholangiocarcinoma (PHC) is still controversial. We compared the outcomes of right (RTS) and left trisectionectomies (LTS) in Bismuth-Corlette (BC) type IV PHC resection. All patients undergoing RTS or LTS for BC type IV PHC in a single tertiary center between January 2012 and December 2019 were compared retrospectively. The endpoints were perioperative outcomes, long-term overall (OS), and disease-free survival (DFS). Among 67 hepatic resections for BC type IV PHC, 25 (37.3%) were LTS and 42 (63.7%) were RTS. Portal vein and artery resection rates were 40% and 52.4% (<i>p</i> = 0.29), and 24% and 0% (<i>p</i> < 0.001) in the LTS and RTS groups, respectively. The severe complication (Clavien–Dindo > IIIa) rate was comparable (36% vs. 21.5%, <i>p</i> = 0.357) while the postoperative liver failure (POLF) rate was lower in the LTS group (16% vs. 38%, <i>p</i> = 0.048). The R0 resection rate was similar between groups (81% vs. 92%; <i>p</i> = 0.154). The five-year OS rate was higher in the LTS group (66% vs. 30%, <i>p</i> = 0.009) while DFS was comparable (43% vs. 18%, <i>p</i> = 0.11). Based on multivariable analysis, the side of the trisectionectomy was an independent predictor of OS. Compared with RTS, LTS is associated with lower POLF and higher overall survival despite more frequent arterial reconstructions in type IV PHC. Although technically more demanding, LTS may be preferred in the treatment of advanced PHC. |
| first_indexed | 2024-03-10T01:26:16Z |
| format | Article |
| id | doaj.art-d41507c13cd948a8a54b3694b21494e7 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:26:16Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-d41507c13cd948a8a54b3694b21494e72023-11-23T13:51:10ZengMDPI AGCancers2072-66942022-06-011411279110.3390/cancers14112791Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy?Heithem Jeddou0Stylianos Tzedakis1Francesco Orlando2Antoine Robert3Eric Meneyrol4Damien Bergeat5Fabien Robin6Laurent Sulpice7Karim Boudjema8Department of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Radiology, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University of Rennes 1, 35000 Rennes, FranceHow the side of an extended liver resection impacts the postoperative prognosis of advanced perihilar cholangiocarcinoma (PHC) is still controversial. We compared the outcomes of right (RTS) and left trisectionectomies (LTS) in Bismuth-Corlette (BC) type IV PHC resection. All patients undergoing RTS or LTS for BC type IV PHC in a single tertiary center between January 2012 and December 2019 were compared retrospectively. The endpoints were perioperative outcomes, long-term overall (OS), and disease-free survival (DFS). Among 67 hepatic resections for BC type IV PHC, 25 (37.3%) were LTS and 42 (63.7%) were RTS. Portal vein and artery resection rates were 40% and 52.4% (<i>p</i> = 0.29), and 24% and 0% (<i>p</i> < 0.001) in the LTS and RTS groups, respectively. The severe complication (Clavien–Dindo > IIIa) rate was comparable (36% vs. 21.5%, <i>p</i> = 0.357) while the postoperative liver failure (POLF) rate was lower in the LTS group (16% vs. 38%, <i>p</i> = 0.048). The R0 resection rate was similar between groups (81% vs. 92%; <i>p</i> = 0.154). The five-year OS rate was higher in the LTS group (66% vs. 30%, <i>p</i> = 0.009) while DFS was comparable (43% vs. 18%, <i>p</i> = 0.11). Based on multivariable analysis, the side of the trisectionectomy was an independent predictor of OS. Compared with RTS, LTS is associated with lower POLF and higher overall survival despite more frequent arterial reconstructions in type IV PHC. Although technically more demanding, LTS may be preferred in the treatment of advanced PHC.https://www.mdpi.com/2072-6694/14/11/2791perihilar cholangiocarcinomaBismuth type IVright trisectionectomyleft trisectionectomy |
| spellingShingle | Heithem Jeddou Stylianos Tzedakis Francesco Orlando Antoine Robert Eric Meneyrol Damien Bergeat Fabien Robin Laurent Sulpice Karim Boudjema Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? Cancers perihilar cholangiocarcinoma Bismuth type IV right trisectionectomy left trisectionectomy |
| title | Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? |
| title_full | Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? |
| title_fullStr | Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? |
| title_full_unstemmed | Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? |
| title_short | Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy? |
| title_sort | liver resection for type iv perihilar cholangiocarcinoma left or right trisectionectomy |
| topic | perihilar cholangiocarcinoma Bismuth type IV right trisectionectomy left trisectionectomy |
| url | https://www.mdpi.com/2072-6694/14/11/2791 |
| work_keys_str_mv | AT heithemjeddou liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT stylianostzedakis liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT francescoorlando liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT antoinerobert liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT ericmeneyrol liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT damienbergeat liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT fabienrobin liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT laurentsulpice liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy AT karimboudjema liverresectionfortypeivperihilarcholangiocarcinomaleftorrighttrisectionectomy |