Trends in surgical outcomes for perihilar cholangiocarcinoma: Insights from a Western tertiary center.

INTRODUCTION

Following the aggressive surgical approach proposed by Japanese authors, the management of perihilar cholangiocarcinoma (PHCC) has evolved over time.

OBJECTIVE

to assess the improvement of surgical outcomes in PHCC patients in a Western tertiary center over the last three decades.

METHOD: 196 PHCC patients underwent curative resection at Verona University Hospital, Italy. Perioperative data were analyzed by comparing early (1995-2004), intermediate (2005-2014), and late (2015-2024) period with the Cochran-Armitage test.

RESULTS

24, 64, and 108 patients underwent surgery in early, intermediate, and late period, respectively. An increased trend in preoperative biliary drainage (38%, 72%, 75%, p = 0.002) portal vein embolization (0%, 6%, 19%, p = 0.003), extended hepatectomies (0%, 13%, 17%, p = 0.040) and vascular resections (4%, 16%, 24%, p = 0.017) was observed. The median number of lymph nodes retrieved increased (3, 9, 9, p < 0.001) while R1 resection decreased (42%, 36%, 34%, p = 0.524). A downward trend of major complications (54%, 39%, 39%, p = 0.274) and 90-day mortality (17%, 8%, 6%, p = 0.152) was reported. Adjuvant therapy rate progressively increased (0%, 39%, 58%, p < 0.001). The 5-year survival was 13%, 29%, 50% in early, intermediate, and late period, respectively (p < 0.001).

CONCLUSION

Advances in PHCC management have led to increased survival and decreased major complications and 90-day mortality.