The role of surgical approach in recovery from extrahepatic cholangiocarcinoma: hemihepatectomy vs. pancreatoduodenectomy

This study compared short- and mid-term outcomes of hemihepatectomy (HH) and pancreatoduodenectomy (PD) in patients with extrahepatic cholangiocarcinoma, focusing on surgical outcomes, body composition, and nutritional status.

A retrospective review was conducted to assess short-term outcomes, including operative time, blood loss, complications, and mortality. Body composition and nutritional parameters were analyzed preoperatively and 1 year postoperatively. Multivariate analysis identified factors influencing outcomes.

Among 216 patients (HH: n = 94, PD: n = 122), HH was associated with younger age (median 72 vs. 74 years, p = 0.041), longer operative times (p = 0.008), and greater blood loss (p < 0.001) compared to PD. Despite this, HH had fewer severe complications (42.6% vs. 75.4%, p < 0.001), lower rates of pancreatic fistula (5.3% vs. 60.7%, p < 0.001), and shorter postoperative hospital stays (p = 0.002). Mortality occurred in 3 HH patients (3.2%), all of whom underwent right hemihepatectomy, compared to none in PD (p = 0.081). One year postoperatively, HH patients had better preservation of skeletal muscle area (p = 0.139), body fat area (p = 0.319), and hemoglobin levels (p = 0.060) compared to significant declines observed in PD patients (all p < 0.001). Multivariate analysis indicated that HH was independently associated with better preservation of skeletal muscle area (β = 2.58, p < 0.001), body fat area (β = 20.86, p < 0.001), and hemoglobin levels (β = 0.81, p = 0.009) at one year postoperatively.

HH was associated with better preservation of physical and nutritional status compared to PD. However, the higher perioperative mortality observed in HH, particularly right hemihepatectomy, necessitates careful consideration of the risks and benefits when selecting the surgical approach for patients with extrahepatic cholangiocarcinoma.