Left extended hepatectomy (H123458-B) versus right extended hepatectomy (H145678-B) for hilar cholangiocarcinoma: A single center comparative analysis of surgical outcomes and survival

Backgrounds/Aims: Surgical resection is the only curative treatment for cholangiocarcinoma. In selected cases, extended hepatectomies, including right extended hepatectomy (REH; H145678-B) and left extended hepatectomy (LEH; H123458-B), are required. This study compares perioperative outcomes and long-term survival between LEH and REH. Methods: We retrospectively reviewed prospectively maintained data for all patients who underwent extended hepatectomies for hilar cholangiocarcinoma at a single institution between 2016 and 2022. Perioperative metrics and long-term outcomes were compared between groups. Results: = 0.014). LEH was associated with shorter hospital stays (17 vs. 27 days) and lower 90-day mortality (0% vs. 17%). R0 resection rates were comparable (LEH: 90% vs. REH: 84%). Median disease-free survival was 12 months for LEH and 17 months for REH; median overall survival was 29 months for LEH and 37 months for REH. Conclusions: LEH may offer a superior safety profile, with lower PHLF incidence and shorter hospital stays compared to REH, while achieving similar oncologic outcomes. In anatomically suitable cases, LEH should be considered a potentially safer option for hilar cholangiocarcinoma.