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Comparison analysis of left-side versus right-side resection in bismuth type III hilar cholangiocarcinoma
Ann Hepatobiliary Pancreat Surg 2018 Nov;22(4):350-8
Published online November 30, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

YouJin Lee1, DongWook Choi1, Sunjong Han2, In Woong Han1, Jin Seok Heo1, Seong Ho Choi1

1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 2Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
Received September 17, 2018; Revised October 2, 2018; Accepted October 4, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Several studies report worse prognosis after left-side compared to right-side liver resection in patients with perihilar cholangiocarcinoma. In this study, we compared outcomes of left-side and right-side resections for Bismuth type III hilar cholangiocarcinoma and analyzed factors affecting survival. 
Methods: From May 1995 to December 2012, 179 patients underwent surgery at Samsung Medical Center for type III hilar cholangiocarcinoma. Among these patients, 138 received hepatectomies for adenocarcinoma with curative intent: 103 had right-side resections (IIIa group) and 35 had left-side resections (IIIb group). Perioperative demographics, morbidity, mortality, and overall and disease-free survival rates were compared between the groups. 
Results: BMI was higher in the IIIa group (24±2.6 kg/m2 versus 22.7±2.8 kg/m2; p=0.012). Preoperative portal vein embolization was done in 23.3% of patients in the IIIa group and none in the IIIb group. R0 rate was 82.5% in the IIIa group and 85.7% in the IIIb group (p=0.796) and 3a complications by Clavien-Dindo classification were significantly different between groups (10.7% for IIIa versus 23.3% for IIIb; p=0.002). The 5-year overall survival rate was 33% in the IIIa group and 35% in the IIIb group (p=0.983). The 5-year disease-free survival rate was 28% in the IIIa group and 29% in the IIIb group (p=0.706). Advanced T-stages 3 and 4 and LN metastasis were independent prognostic factors for survival and recurrence by multivariate analysis. 
Conclusions: No significant differences were seen in outcomes by lesion side in patients receiving curative surgery for Bismuth type III hilar cholangiocarcinoma.
Keywords : Hilar cholangiocarcinoma; Klatskin tumor; R0 resection; Right hepatectomy; Left hepatectomy


November 2018, 22 (4)