Does Portal Vein Resection Affect Outcome After Major Hepatectomy for Perihilar Cholangiocarcinoma? A Single-Center Experience

Background: Portal vein resection (PVR) extends curative-intent surgery for locally advanced perihilar cholangiocarcinoma (pCCA). However, whether PVR independently affects perioperative and long-term outcomes remains unclear. This study evaluated the impact of PVR on outcomes after major hepatectomy for pCCA in a single-center experience. Methods: Overall, 171 consecutive patients who underwent single-stage curative-intent major hepatectomy for pCCA between 2003 and 2023 were analyzed, of whom 34 (19.9%) underwent PVR. Factors associated with 90-day mortality were analyzed by penalized logistic regression. Overall survival (OS) was analyzed in all 171 patients, including postoperative deaths, by Kaplan–Meier and Cox regression, and in 90-day survivors as a secondary landmark analysis. Results: The in-hospital mortality was 14.7% after PVR and 8.0% without PVR (p = 0.319). The 90-day mortality was 17.6% and 13.9% (p = 0.591); it was associated with age (OR 1.05 per year, p = 0.021) and extended hepatectomy (OR 3.92, p = 0.002), whereas no statistically significant association with PVR was detected (OR 1.31, 95% CI 0.43–3.62). Median OS was 15.4 months after PVR and 33.9 months without PVR (5-year OS 17.2% vs. 33.8%; p = 0.009), and PVR was associated with shorter OS after adjustment (HR 1.75, 95% CI 1.09–2.79). Among 90-day survivors, this association was weaker and not statistically significant (HR 1.54, 95% CI 0.85–2.78). Conclusions: PVR was not significantly associated with 90-day mortality, which was associated with age and the extent of hepatectomy. PVR was associated with shorter OS, whereas the association among 90-day survivors was weaker and statistically uncertain. When technically feasible, PVR may be considered to achieve a curative resection in carefully selected patients, with particular attention to age and the extent of the planned hepatectomy.