Ann Surg Treat Res.  2023 Nov;105(5):319-332. 10.4174/astr.2023.105.5.319.

Short-term and long-term clinical outcomes of combined major vessel resection for hilar cholangiocarcinoma: a propensity score analysis

• Wang Y
• Lu J

• KMID: 2547537
• DOI: http://doi.org/10.4174/astr.2023.105.5.319

Abstract

Purpose
In the treatment of hilar cholangiocarcinoma (HCCA), combined resection of important hepatic vessels remains controversial. The purpose of this study was to compare the postoperative complications and prognosis of combined and non-combined major vessel resections in patients undergoing radical resection for HCCA.
Methods
In this study, patients with HCCA who underwent curative resection between January 2007 and December 2018 were retrospectively enrolled. Postoperative complications and prognosis between the groups were compared using propensity score-matching (PSM) analysis.
Results
There were 310 patients included in this study. The portal vein resection (PVR) and hepatic artery resection (HAR) groups had a higher incidence of postoperative complications than the control group. Patients in the HAR group had an increased risk of abdominal and pleural effusion after surgery. Patients who underwent combined PVR had better overall survival (OS; P = 0.020) and disease-free survival (DFS; P = 0.020). After curative-intent resection, patients in the HAR group had improved OS (P = 0.027) and DFS (P = 0.023). The postoperative complications of combined vascular resection (VR) did not worsen long-term survival for patients.
Conclusion
In patients with HCCA, combined VR improved prognosis. The postoperative complications of combined VR do not worsen patient survival. Therefore, radical surgical resection is recommended.

Keyword

Klatskin tumor; Vessel resection; Postoperative complications; Propensity score; Cohort studies

Figure

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  Fig. 1 After propensity score-matching matching. Overall survival (A) and disease-free survival (B) for patients in the portal vein resection (PVR) group and non-PVR group (n = 170).

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  Fig. 2 After propensity score-matching matching. Overall survival (A) and disease-free survival (B) for patients in the hepatic artery resection (HAR) group and non-HAR group (n = 94).

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  Fig. 3 After propensity score-matching matching. (A, B) Impact of overall postoperative complications on the prognosis of patients who underwent major vessel resection. (C, D) Impact of Clavien-Dindo grade I/II postoperative complications on the prognosis of patients who underwent major vessel resection. (E, F) Impact of Clavien-Dindo grade III/IV postoperative complications on the prognosis of patients who underwent major vessel resection. (A, C, E) Overall survival; (B, E, F)

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