Sistema de Salut de Catalunya
Institut Català de la Salut
[Poletto E] Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy. Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. [Olthof PB] Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. [Hoogwater FJH] Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. [Erdmann JI] Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. [Schnitzbauer AA] Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany. [Sparrelid E] Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. [Dopazo C] Servei de Cirurgia Hepatobiliopancreàtica i Trasplantaments, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-11-17T13:44:15Z
2025-11-17T13:44:15Z
2025-12
Biliary tract cancer; Oncological outcomes; Perihilar cholangiocarcinoma
Cáncer de las vías biliares; Resultados oncológicos; Colangiocarcinoma perihiliar
Càncer de les vies biliars; Resultats oncològics; Colangiocarcinoma perihilar
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.
Article
Published version
English
Avaluació de resultats (Assistència sanitària); Conductes biliars - Càncer - Cirurgia; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Digestive System Surgical Procedures::Hepatectomy; DISEASES::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Biliary Tract Neoplasms::Bile Duct Neoplasms; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; DISEASES::Neoplasms::Neoplasms by Histologic Type::Neoplasms, Glandular and Epithelial::Carcinoma::Adenocarcinoma::Cholangiocarcinoma::Klatskin Tumor; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::hepatectomía; ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias del tracto biliar::neoplasias de los conductos biliares; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento; ENFERMEDADES::neoplasias::neoplasias por tipo histológico::neoplasias glandulares y epiteliales::carcinoma::adenocarcinoma::colangiocarcinoma::tumor de Klatskin
Springer Nature
Annals of Surgical Oncology;32
https://doi.org/10.1245/s10434-025-18137-4
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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