Minor hepatectomy combined with cholangioplasty and cholangiojejunostomy for Bismuth II hilar cholangiocarcinoma: A propensity score matching analysis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: England NLM ID: 8504356 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2157 (Electronic) Linking ISSN: 07487983 NLM ISO Abbreviation: Eur J Surg Oncol Subsets: MEDLINE
    • Publication Information:
      Publication: : Amsterdam : Elsevier
      Original Publication: London ; New York : Academic Press, [1985-
    • Subject Terms:
      Hepatectomy*/methods ; Bile Duct Neoplasms*/surgery ; Propensity Score* ; Klatskin Tumor*/surgery ; Operative Time*; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Quality of Life ; Blood Loss, Surgical/statistics & numerical data ; Postoperative Complications/epidemiology ; Length of Stay/statistics & numerical data ; Survival Rate ; Jejunostomy/methods
    • Abstract:
      Background: The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy.
      Materials and Methods: One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n = 31) or major (n = 31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%).
      Results: Minor hepatectomy had a significantly shorter operation time (245.42 ± 54.31 vs. 282.16 ± 66.65 min; P = 0.023), less intraoperative blood loss (194.19 ± 149.17 vs. 315.81 ± 256.80 mL; P = 0.022), a lower transfusion rate (4 vs. 11 patients; P = 0.038), more rapid bowel recovery (17.77 ± 10.00 vs. 24.94 ± 9.82 h; P = 0.005), and a lower incidence of liver failure (1 vs. 6 patients; P = 0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8 % vs. 22.6 %; P = 0.648), and 3-year disease-free survival (12.9 % vs. 16.1 %; P = 0.989) were comparable between the groups.
      Conclusion: In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.
      (© 2024 Published by Elsevier Ltd.)
    • Contributed Indexing:
      Keywords: Hilar cholangiocarcinoma; Major hepatectomy; Minor hepatectomy; Perioperative outcomes; Propensity score matching
    • Publication Date:
      Date Created: 20240419 Date Completed: 20240524 Latest Revision: 20240524
    • Publication Date:
      20240525
    • Accession Number:
      10.1016/j.ejso.2024.108339
    • Accession Number:
      38640604