Groot Koerkamp, Bas

Olthof, Pim B.

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   University of GroningenASO Author Reflectionsthe Perihilar Cholangiocarcinoma Collaboration Group; Olthof, Pim B.; Groot Koerkamp, BasPublished in:Annals of surgical oncologyDOI:10.1245/s10434-024-15156-5IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2024Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):the Perihilar Cholangiocarcinoma Collaboration Group, Olthof, P. B., & Groot Koerkamp, B. (2024). ASOAuthor Reflections: Surgical Strategy for Perihilar Cholangiocarcinoma. Annals of surgical oncology, 31(7),4454-4455. https://doi.org/10.1245/s10434-024-15156-5CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 12-12-2024Vol:.(1234567890)Ann Surg Oncol (2024) 31:4454–4455https://doi.org/10.1245/s10434-024-15156-5ASO AUTHOR REFLECTIONSASO Author Reflections: Surgical Strategy for Perihilar CholangiocarcinomaPim B. Olthof, MD, PhD1,2,3, and Bas Groot Koerkamp, MD, PhD1 on behalf of the Perihilar Cholangiocarcinoma Collaboration Group1Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands; 3Department of Surgery, University Medical Center, Groningen, Groningen, The Netherlands PASTThe goal in the surgical treatment of perihilar cholangio-carcinoma is complete R0 resection, which usually requires major liver resection. The extent of biliary or vascular involvement can dictate the side of the liver that has to be resected. In other cases, a left- or right-sided liver resection can be chosen, which is a frequent subject of debate. Often, an extended right hepatectomy is advocated for the highest probability of R0 resection, however this is associated with a high risk of liver failure due to the small liver remnant.1,2PRESENTWe performed a large retrospective study on 816 patients who underwent left-sided liver resection and 855 patients who underwent right-sided liver resection for perihilar chol-angiocarcinoma.3 The 90-day mortality rate after right-sided resection was twice that after left-sided resection (18% vs. 9%; p < 0.001). Positive resection margins were similar for both groups but median overall survival was 23 months after right-sided liver resection and 30 months after left-sided liver resection (p < 0.001).FUTUREThis study is the largest to date on this subject and high-lights that a left-sided resection strategy is better tolerated and is associated with better survival. This study contradicts that extended right hepatectomy should be preferentially per-formed for perihilar cholangiocarcinoma. It also highlights that the perioperative risks of perihilar cholangiocarcinoma surgery are among the highest of any elective cancer sur-gery. Modifiable risk factors to decrease liver failure after extended right hepatectomy include better preoperative bil-iary drainage with less preoperative cholangitis, and liberal use of portal/hepatic vein embolization.4,5 A prospective study including all surgical decision-making details might be essential to finally settle the debate on the optimal surgi-cal approach.ACKNOWLEDGMENT Perihilar Cholangiocarcinoma Collabo-ration Group: Aldrighetti L, Alikhanov R, Bartsch F, Bechstein WO, Bednarsch J, Benzing C, de Boer MT, Bouwense SA, Buettner S, Capo-bianco I, Cescon M, Charco R, D’Angelica MI, Dewulf M, de Reuver P, de Savornin Lohman E, Efanov M, Erdmann JI, Franken LC, Geers J, Giglio MC, Gilg S, Gomez-Gavara C, Guglielmi A, van Gulik TM, Hagendoorn J, Hakeem A, Heil J, Hoogwater FJH, IJzermans JNM, Jansson H, Jarnagin WR, Kazemier G, Kingham TP, Lang H, Lodge P, Maithel SK, Malago M, Malik HZ, Margies R, Marino R, Molenaar QI, Nadalin S, Neumann U, Nguyen TA, Nooijen LE, Nota C.L.M, Olde Damink SWM, Poletto E,Porte RJ, Prasad R, Pratschke J, Quinn LM, Ratti F, Ravaioli M, Roberts KJ, Rolinger J, Ruzzenente A, Schadde E, Schmelzle M, Schnitzbauer AA, Serenari M, Sparrelid E, Sultana A, Topal B, Troisi RI, van Laarhoven S, Zonderhuis BM.DISCLOSURE Pim B. Olthof and Bas Groot Koerkamp report no relevant conflicts of interest or relevant funding.OPEN ACCESS This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adap-tation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, This article refers to: Olthof PB, Erdmann JI, Alikhanov R, et al. Higher postoperative mortality and inferior survival after right-sided liver resection for perihilar cholangiocarcinoma: left-sided resection is preferred when possible. Ann Surg Oncol. 2024. https:// doi. org/ 10. 1245/ s10434- 024- 15115-0© The Author(s) 2024First Received: 20 February 2024 Accepted: 20 February 2024 Published online: 6 March 2024P. B. Olthof, MD, PhD e-mail: p.olthof@erasmusmc.nl4455ASO Author Reflections: Surgical Strategy …  provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES 1. Lang H, van Gulik TM. Extended right-hemihepatectomy is preferred for perihilar cholangiocarcinoma. Ann Surg. 2021;274(1):33–4. 2. Matsumoto N, Ebata T, Yokoyama Y, Igami T, Sugawara G, Shimoyama Y, et al. Role of anatomical right hepatic tri-sectionectomy for perihilar cholangiocarcinoma. Br J Surg. 2014;101(3):261–8. 3. Olthof PB, Erdmann JI, Alikhanov R, et al. Higher postoperative mortality and inferior survival after right-sided liver resection for perihilar cholangiocarcinoma: left-sided resection is preferred when possible. Ann Surg Oncol. 2024. https:// doi. org/ 10. 1245/ s10434- 024- 15115-0 4. Olthof PB, Wiggers JK, Groot Koerkamp B, Coelen RJ, Allen PJ, Besselink MG, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization. J Am Coll Surg. 2017;225(3):387–94. 5. Wiggers JK, Groot Koerkamp B, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg. 2016;223(2):321-31 e1.Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

ASO Author Reflections:Surgical Strategy for Perihilar Cholangiocarcinoma

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ASO Author Reflections:Surgical Strategy for Perihilar Cholangiocarcinoma

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