[Efficacy and safety of resection of hilar cholangiocarcinoma with left hepatectomy after pre-operative embolization of the invaded right hepatic artery].

Objective: To compare the efficacy and safety of left hepatectomy with sequential embolization of the tumor-invaded right hepatic artery (RHA) followed by resection without reconstruction versus left hepatectomy with RHA resection and reconstruction for the treatment of hilar cholangiocarcinoma (HCCA). Methods: A retrospective cohort of 10 HCCA patients undergoing the SERRHA protocol between January 2023 and January 2025 at the Sun Yat-sen Memorial Hospital, Department of Biliary and Pancreatic Surgery, was included (SERRHA group). A control group of 24 HCCA patients undergoing left hepatectomy with RHA resection and reconstruction between January 2014 and January 2025 was established (RRRHA group). Follow-up was conducted until April 30, 2025. The incidence of 90-day Clavien-Dindo≥Grade Ⅲ complications, R0 resection rates, and postoperative survival were compared. Results: The SERRHA group included 10 cases, aged (57.6 ± 16.3) years, with 3 males. The RRRHA group included 24 cases, aged (57.3 ± 11.1) years, with 15 males. In the SERRHA group, 2 patients (2/10) developed left liver abscesses post-embolization. There were no 90-day or in-hospital deaths. Median follow-up was 9.3 months (95%CI: 3.6-15.0). In the RRRHA group, there was 1 peri-operative death due to anastomotic haemorrhage. Median follow-up was 44.5 months (95%CI: 25.8-63.2). Median overall survival (OS) was 29.0 months (95%CI: 9.3-48.7), with 1-, 3-, and 5-year OS rates of 90.8%, 45.6%, and 20.3%, respectively. There were no statistically significant differences (P>0.05) between the SERRHA and RRRHA groups in 90-day Clavien-Dindo≥Grade Ⅲ complications [5/10 vs 20.8% (5/24)], R0 resection rate [4/10 vs 70.8% (17/24)], or 1-year OS (83.3% vs 90.8%). Conclusion: For HCCA with RHA invasion where resection and reconstruction are difficult, left hepatectomy following RHA embolization demonstrates a certain degree of safety, and its short-term efficacy is similar to that of cases with RHA resection and reconstruction.