Right-side versus left-side hemihepatectomy for the treatment of Bismuth type IV perihilar cholangiocarcinoma: a comparative study

Objective Radical surgical resection is the only potentially curative treatment for perihilar cholangiocarcinoma (PHC) patients. However, data on left-sided hemihepatectomy (LH) and right-sided hemihepatectomy (RH) outcomes for Bismuth-Corlette type IV PHC are scarce and controversial. This study aimed to explore surgical and long-term outcomes of LH and RH in these patients. Methods Medical records of Bismuth type IV PHC patients who had liver resection from 2009 to 2018 were retrospectively analyzed. Surgical results and long-term survival were the primary outcomes, compared via one-to-one propensity score matching (PSM). Results 218 Bismuth type IV PHC patients (146 LH, 72 RH) were analyzed. The RH group had a higher proportion of preoperative biliary drainage (p = 0.02) and more frequent portal vein embolization (p < 0.0001). R0 resection rate was 90.37% (197/218) with no significant LH-RH difference. Post-operative severe complication (grades 3-5) and 90-day mortality rates were comparable. Overall survival was similar (overall cohort: p=0.21; matched cohort: p=0.54). But in the overall cohort, R0-resected RH patients had marginally better survival (p = 0.064). Prognostic factors included carbohydrate antigen 19-9 (CA19-9), age, tumor vascular invasion, and severe post-operative complications. Conclusions The postoperative morbidity and mortality rate was comparable between LH and RH for Bismuth type IV PHC. Although RH showed a favorable survival from the Kaplan-Meier survival curve, no significant difference was observed in overall survival after LH versus RH for the overall cohort and the matched cohort after PSM.