Evaluation of Extrahepatic Bile Duct Resection as a Parenchyma-Preserving Alternative in Bismuth I-II Perihilar Cholangiocarcinoma: A Comparative Single-Center Analysis.

Abstract

Introduction: Perihilar cholangiocarcinoma (pCCA) is an aggressive biliary malignancy usually requiring major hepatectomy, which carries substantial morbidity and mortality. In selected patients with Bismuth-Corlette Type I-II tumors, isolated extrahepatic bile duct resection (EH) may represent a parenchyma-preserving alternative. However, comparative outcome data remain limited. This study evaluated perioperative and long-term outcomes following EH and major hepatectomy (MH).

Methods: Of 305 consecutive patients undergoing surgery for perihilar cholangiocarcinoma between 2010 and 2024, 49 with the uncommon Bismuth-Corlette Type I-II disease met the inclusion criteria and underwent either major hepatectomy (n = 26) or extrahepatic bile duct resection (n = 23) with lymphadenectomy. Surgical selection was based on liver function, comorbidities, and tumor extent. Perioperative outcomes and overall survival were compared.

Results: EH patients were older (p = 0.01) and had more hepatic comorbidities (21.7% vs. 0%, p = 0.010). MH was associated with more severe complications (p = 0.013). R0 resection rates were similar (p = 0.88). One-, three-, and five-year overall survival did not differ significantly (EH: 82%, 47%, 24%; MH: 72%, 47%, 27%; p = 0.472).

Conclusion: MH remains the standard treatment for medically fit patients with pCCA. In carefully selected, high-risk patients with anatomically limited Bismuth-Corlette Type I-II tumors, isolated EH may provide lower perioperative morbidity while achieving acceptable long-term outcomes.