Long-term outcomes of hepatopancreatoduodenectomy for perihilar cholangiocarcinoma: A comparative study with conventional hepatectomy.

Abstract

Introduction: Hepatopancreatoduodenectomy (HPD) is necessary to achieve a reliable margin-negative resection for widespread perihilar cholangiocarcinoma (PhCC), yet data on long-term outcomes following HPD for PhCC remain limited.

Materials and methods: A retrospective cohort study was conducted on 167 patients with PhCC who underwent surgery with curative-intent between 2000 and 2023. Hepatic resection and extrahepatic bile duct resection (Hr-BDR) were performed for cases presumed to have localized tumors, while HPD was conducted for cases with presumed extensive tumor spread. Short- and long-term outcomes, including surgery details, pathological findings, postoperative complications, survival rates, and recurrence patterns, were compared.

Results: Forty-five patients underwent HPD and 122 underwent Hr-BDR. No differences were observed in the T or N factors of the TNM staging between both groups (P = 0.09 and 0.09). Overall postoperative significant complications (38 % vs. 34 %, P = 0.62), 90-day mortality rates (2 % vs. 2 %, P = 0.80), and 5-year cancer-specific survival (45 % vs. 40 %, P = 0.81) were comparable between both groups. However, the 5-year survival rate of the HPD group was significantly higher than that of the Hr-BDR group with positive invasive duodenal-side ductal margins (45 % vs. 0 %, P = 0.03). Local and remnant bile duct recurrence were significantly less frequent in the HPD than in the Hr-BDR group (20 % vs. 37 %, P = 0.04; 11 % vs. 0 %, P = 0.02, respectively).

Conclusion: Although HPD for widespread PhCC requires careful postoperative management, it has the potential to provide excellent long-term outcomes, and it should be considered proactively.