Surgery for Hilar cholangiocarcinoma: the Newcastle upon Tyne Liver Unit experience

Abstract

Background: Hilar cholangiocarcinoma (HCCA) arises from the confluence of the common hepatic duct and has a poor prognosis. If resectable, an extended left (eLH) or right hemihepatectomy (eRH) is usually required to provide oncological clearance. We reviewed outcomes for patients with HCCA managed at our centre. Methods: Electronic records of patients referred to our centre for HCCA were retrospectively reviewed. The Kaplan–Meier method was used to estimate overall survival (OS) with the log rank test used for significance (p < 0.05). A Cox regression was performed to ascertain factors that may influence survival. Results: 156 HCCA patients were identified (44 resected versus 112 non-resected). Resected patients had longer OS compared to non-resected patients (50.3 versus 9.8 months, p < 0.001). Patients who underwent an eLH (n = 15) had significantly longer OS at 3 years compared to eRH patients (67.7 vs. 42.1%, respectively; p = 0.007). An eLH was an independent predictor of survival (HR 0.43, p = 0.04). Lymph node positivity (n = 23, hazard ratio 1.72, p = 0.027) and the presence of microvascular invasion (n = 28, hazard ratio 1.78, p = 0.047) were independent predictors of mortality. The frequency of lymph node positivity and microvascular invasion did not differ between eLH and eRH patients (p > 0.05). Conclusion: Patients undergoing an eLH for HCCA have significantly better long-term outcomes compared to those undergoing eRH, independent of other pathological variables. The functional liver remnant (FLR) is usually smaller following eRH, resulting in a higher risk of post-operative liver failure. Combining CT volumetry with PVE may result in better prediction and optimisation of the FLR in the context of eRH for HCCA. Novel findings: An extended left hemihepatectomy is an independent predictor of survival; investigation into the precise interaction between left- and right-sided resections and pre- and post-embolization liver volume is warranted.