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Surgical Results of Concomitant Hepatic Artery Resection for Perihilar Cholangiocarcinoma: A Propensity Score-Matching Study
Takehiro Noji*, Keisuke Okamura, Takahiro Tsuchikawa, Eiji Tamoto, Yoshitsugu Nakanishi, Toshimichi Asano, Toshiaki Shichinohe, Satoshi Hirano
Gastroenterological surgery II, Hokkaido University, Sapporo, Hokkaido, Japan
Background: Whether concomitant hepatic artery resection (AR) improves the prognosis for advanced perihilar cholangiocarcinoma remains controversial. To the best of our knowledge, the few studies that have examined this issue were all retrospective cohort studies. Therefore, the present study aimed to compare short- and long-term surgical results of AR compared to standard resection (SR) for perihilar cholangiocarcinoma using propensity score-matching.
Patients and methods: Between January 2001 and September 2015, a total of 209 patients underwent resection of perihilar cholangiocarcinoma in our department. Twenty-eight patients underwent AR (AR group), and the remaining 181 patients underwent SR (SR group). To correct differences in clinicopathological factors, including difficulty, between groups, propensity score-matching was used at a 1:1 ratio, resulting in a comparison of 24 patients per group. We compared short- and long-term outcomes for AR and SR groups to investigate the feasibility of AR.
Results: The two groups were well balanced by propensity score-matching and 24 patients were matched. In the AR group, 14 patients received vascular reconstruction by microscopic vascular anastomosis, 9 patients underwent vascular reconstruction by arterial portal shunting, and the other patient did not require vascular reconstruction. Median operation time was significantly longer with the AR group (640 min vs. 778 min, P < 0.002), but no significant differences in overall incidence of postoperative complication were seen (Clavien-Dindo classification IIIa: 37.5% in SR group vs. 62.5% in AR group: p=0.08), except for postoperative liver abscess formation (p=0.020). Three-year overall survival rates in each group were 74.1% (SR group) and 32.7% (AR group), and 5-year survival rates were 30.3% and 20.4%, respectively. No significant differences in overall survival were evident between the groups (p=0.150).
Conclusion: Although a demanding procedure, concomitant AR for perihilar cholangiocarcinoma appears feasible.
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