Liver transplantation for perihilar cholangiocarcinoma is not a provocative idea

International audienc

Comment on "Hypothermic machine perfusion in liver transplantation-a randomized trial"

International audienc

Biliary tract viability assessment and sequential hypothermic-normothermic perfusion in liver transplantation

International audienc

COVID-19: Thoughts and comments from a tertiary liver transplant center in France

International audienc

Venous stent in liver transplant candidates: Dodging the top tip traps

International audienceTransjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for refractory ascites, upper gastrointestinal bleeding, or hepatorenal syndrome in liver transplant candidates.

Liver Resection for Type IV Perihilar Cholangiocarcinoma: Left or Right Trisectionectomy?

International audienceSimple Summary Surgical resection of perihilar cholangiocarcinoma (PHC), a rare malignant bile duct tumor arising in the hepatic hilum, requires either right- or left-sided liver resections depending on tumor-side predominance. Margin-free resection remains the only curative-intent treatment and extended liver resections (trisectionectomies) are needed for advanced (Bismuth type IV) PHC. However, the clinical outcomes of left (LTS) and right trisectionectomies (RTS) have so far not been compared for the resection of advanced PHC. In this retrospective study of consecutive cases of Bismuth type IV PHC, RTS (42 patients) and LTS (25 patients) were compared in terms of postoperative morbidity and patient survival. Although LTS was more frequently associated with arterial reconstructions, the postoperative liver failure rate was lower and overall survival was better as compared to RTS. How the side of an extended liver resection impacts the postoperative prognosis of advanced perihilar cholangiocarcinoma (PHC) is still controversial. We compared the outcomes of right (RTS) and left trisectionectomies (LTS) in Bismuth-Corlette (BC) type IV PHC resection. All patients undergoing RTS or LTS for BC type IV PHC in a single tertiary center between January 2012 and December 2019 were compared retrospectively. The endpoints were perioperative outcomes, long-term overall (OS), and disease-free survival (DFS). Among 67 hepatic resections for BC type IV PHC, 25 (37.3%) were LTS and 42 (63.7%) were RTS. Portal vein and artery resection rates were 40% and 52.4% (p = 0.29), and 24% and 0% (p < 0.001) in the LTS and RTS groups, respectively. The severe complication (Clavien-Dindo > IIIa) rate was comparable (36% vs. 21.5%, p = 0.357) while the postoperative liver failure (POLF) rate was lower in the LTS group (16% vs. 38%, p = 0.048). The R0 resection rate was similar between groups (81% vs. 92%; p = 0.154). The five-year OS rate was higher in the LTS group (66% vs. 30%, p = 0.009) while DFS was comparable (43% vs. 18%, p = 0.11). Based on multivariable analysis, the side of the trisectionectomy was an independent predictor of OS. Compared with RTS, LTS is associated with lower POLF and higher overall survival despite more frequent arterial reconstructions in type IV PHC. Although technically more demanding, LTS may be preferred in the treatment of advanced PHC