Surgical Safety after Preoperative Chemotherapy for Perihilar Cholangiocarcinoma: Multi-Institutional Propensity-Matched Analysis.

BACKGROUND

Perihilar cholangiocarcinoma (PHCC) presents a significant clinical challenge, often necessitating extensive hepatectomy in conjunction with extrahepatic bile duct resection (Hx + EBDR). The impact of preoperative chemotherapy on surgical outcomes remains uncertain. This multicenter retrospective cohort study aimed to assess the surgical and survival outcomes of patients with PHCC who received chemotherapy.

METHODS

We conducted a retrospective analysis of 563 patients who underwent extensive hepatectomy with extrahepatic bile duct resection for PHCC, including 81 patients who received preoperative chemotherapy. Propensity score matching was utilized to compare perioperative, pathological, and long-term outcomes between the two groups.

RESULTS

The morbidity and mortality rates in the chemotherapy group were 52% and 4%, respectively. The main postoperative complications were organ/space surgical site infection (27%), bile leakage (26%), and postoperative liver failure (21%), including duplicating occurrences, respectively. Following propensity score matching (n=80 per group), no significant differences were observed in operative time, intraoperative blood loss, morbidity, mortality, or pathological findings, including R0 resection rates. Across the entire cohort, the 5-year overall survival rates were 32.7% for the chemotherapy group and 30.9% for the control group (p=0.982).

CONCLUSIONS

Preoperative chemotherapy for PHCC is associated with comparable surgical morbidity and mortality, despite longer operative times. Propensity score-matched analysis indicates that preoperative chemotherapy does not negatively affect surgical or pathological outcomes.