Extended hepatectomy is associated with improved five- and ten-year survival rates in perihilar cholangiocarcinoma: a population-based analysis of the SEER database (2010–2022)

Background The prognostic factors for long-term survival after resection of perihilar cholangiocarcinoma (pCCA) remain controversial, especially concerning the impact of an extended hepatectomy. This study aimed to identify those affecting five- and ten-year survival rates after pCCA resection. Methods This retrospective analysis examined patients undergoing pCCA resection from the SEER database between 2010 and 2022. The study included patients who underwent a wedge or segmental resection, only bile duct resection, hemi-hepatectomy, or extended hepatectomy. The inclusion criteria were as follows: no distant metastases, at least three months of available follow-up, and death due to biliary cancer or alive at follow-up. After identifying the predictors via univariable analysis, a multivariable binary logistic regression analysis was performed. Results A total of 1,134 patients were included in the study. The following factors were all associated with a higher five-year survival rate in the multivariable analysis: lower age (less than 54 years), OR: 1.6 (95% CI: 1.1–2.5, p=0.016); female sex, OR: 1.4 (95% CI: 1.0–1.9, p=0.040); undergoing an extended hepatectomy, OR: 1.7 (95% CI: 1.3–2.4, p<0.001); resecting more than three lymph nodes or none, OR: 1.7 (95% CI: 1.2–2.5, p=0.005); and nodal negative disease, OR: 3.3 (95% CI: 2.3–4.8, p < 0.001). Higher predictors of a ten-year survival rate were undergoing an extended hepatectomy (OR: 2.1, 95% CI: 1.1–3.9, p=0.019) and nodal negative disease (OR: 3.5 (95% CI: 1.5–8.1), p=0.003. Conclusion Patients undergoing an extended hepatectomy for a pCCA resection have higher five- and ten-year survival rates.