Is there a role for minor resections in perihilar cholangiocarcinoma? Single institutional results from a western center.

In perihilar cholangiocarcinoma major liver resections are often required to attain oncological radicality, but these approaches are associated with a high perioperative morbidity and mortality. The aim of this study was to assess the outcome of minor resections compared to standard major liver resections. A single-institutional database was queried for all patients undergoing resection for perihilar cholangiocarcinoma between 2008 and 2024. Minor resections were defined as resections of the hilar bifurcation including up to three liver segments, whereas major resections exceeded 3 segments. The primary study endpoint was safety and feasibility of resection represented by 30-day mortality. Secondary endpoints included survival outcomes. The primary outcome was evaluated using logistic regression. Survival outcomes were analysed using Kaplan-Meier method and Cox regression. Additionally, a propensity score matching was conducted, grouping variables by age and Bismuth-Classification. Two hundred sixteen patients underwent resection, 182 in the major resection and 34 in the minor resection group. Patients in the minor resection group were older (71.4 vs. 66.0 years, p = 0.007) and had more comorbidities (Charlson Comorbidity Index: 5.3 vs. 4.7, p = 0.03). After propensity score matching demographic data were balanced between groups. Minor resection was consistently associated with a trend toward lower 30-day mortality rate (2.9% vs. 13.7%, p = 0.057). Intraoperative blood loss requiring blood transfusion and length of surgery were independently associated with 30-day mortality, both of which were significantly lower in the minor resection group. Median overall survival was 30.1 months in the minor resection and 23.9 months in the major resection group (p = 0.84). Minor resection in perihilar cholangiocarcinoma was associated with a trend towards reduced and acceptable perioperative mortality at the expense of a lower surgical radicality and long-term survival compared to major resections.