Ann Surg Oncol. 2025 Sep 13. doi: 10.1245/s10434-025-18137-4. Online ahead of print.
ABSTRACT
BACKGROUND: Hepatectomy with associated vascular resection and reconstruction (VR) is an option to increase the number of patients with locally advanced perihilar cholangiocarcinoma (pCCA) eligible for radical-intent surgery.
OBJECTIVES: This study aimed to assess the safety and oncological outcomes of VR in pCCA patients.
METHODS: Patients who underwent surgery for pCCA at 10 western centers were retrospectively reviewed and divided according to the performance of the VR. Primary outcomes were major morbidity, vascular morbidity, 90-day mortality, and overall survival (OS).
RESULTS: A total of 1054 patients were included, of whom 259 (24.6%) underwent VR. Of these 259 patients, 199 (76.8 %) underwent portal vein reconstruction (PVR) only and 60 (23.2%) underwent hepatic artery reconstruction (HAR) with or without PVR. VR patients were younger (66 vs. 68 years; p = 0.011) and more frequently had Bismuth type 4 tumors (31.3% vs. 22.9%; p = 0.008). They more frequently underwent portal vein embolization (32.0% vs. 17.6%; p < 0.001), biliary drainage (84.9% vs. 77.3%; p = 0.008), and extended hepatectomy (56.8% vs. 37.1%; p < 0.001), with longer operative times (539 vs. 479 min; p < 0.001) and higher blood loss (1300 vs. 700 mL; p < 0.001). Positive resection margins were observed more frequently (45.7% vs. 35.2%; p = 0.003). Major complications (51.4% vs. 41.0%; p = 0.004), vascular complications (19.7% vs. 3.3%; p < 0.001), and mortality (16.2% vs. 10.6%; p = 0.02) were higher in VR patients. Median OS was 28.0 months for patients without VR versus 22.8 months for patients with VR (p = 0.18).
CONCLUSIONS: Liver resection and VR in patients with locally advanced pCCA are associated with increased major and vascular morbidity but offer similar survival as patients not undergoing VR; therefore, VR should be considered in selected patients.
PMID:40946124 | DOI:10.1245/s10434-025-18137-4
