Comparative Analysis of Left- Versus Right-sided Resection in Klatskin Tumor Surgery: can Lesion Side be Considered a Prognostic Factor?

Achievement of negative margins is the goal of curative intent surgery for hilar cholangiocarcinoma. This study analyzed factors affecting survival in hilar cholangiocarcinoma patients and compared short- and long-term outcomes of left- and right-sided resections. One hundred and five patients out of 124 diagnosed with Klatskin tumors underwent major liver resection. Sixty-one patients underwent right-sided resections (right group), whereas 44 underwent left-sided resections (left group). Perioperative morbidity, perioperative mortality, and overall and disease-free survival were compared between the groups. Morbidity and mortality were higher in the right group (59 and 8.2 %, respectively) than in the left group (38.6 and 2.3 %, respectively) (p < 0.005). The most frequent cause of death was liver failure. The R0 rate was 75.4 % in the right and 61.4 % in the left group. The 5-year survival rate was 42.8 % in the right and 35.3 % in the left group (p < 0.05). Patients in the left group more frequently developed local recurrence (87 vs. 69 % in the right group). Lesion side impacts outcome: right resections still cause significant morbidity related to extensive parenchymal sacrifice but are associated with better long-term survival because right hepatic pedicle resection enables better radicality compared with left resections.