Central Hepatectomy as an Alternative: A Comparative Study with Conventional Major Hepatectomy for Perihilar Cholangiocarcinoma.

Background: Right-sided hepatectomy (RH) is the standard surgical approach for perihilar cholangiocarcinoma (PHC) due to anatomical considerations but is associated with a high risk of post-hepatectomy liver failure (PHLF). Left-sided hepatectomy (LH) and central hepatectomy (CH) have been proposed as alternative strategies to preserve liver function, but the feasibility and outcomes of CH have not been sufficiently investigated. CH allows for greater preservation of liver parenchyma, potentially reducing the risk of PHLF.

Methods: This retrospective study analyzed 63 patients with PHC who underwent major hepatectomy at the Juntendo University Hospital between January 2019 and March 2024. Patients were categorized into the LH (n = 18), RH (n = 28), and CH (n = 17) groups. Preoperative future liver remnant volume, perioperative outcomes, pathological findings, and long-term outcomes were compared. Statistical significance was set at p < 0.05.

Results: The CH group had a significantly higher future liver remnant volume compared with the RH group (62.7% vs. 45.5%; p < 0.001). The incidence of PHLF was lower in CH (11.8%) than RH (39.3%), although not statistically significant. CH was associated with a longer median operative time (691 min) and a higher incidence of bile leakage (47.1%). R0 resection rates and long-term outcomes were comparable among the three groups.

Conclusions: CH is a feasible alternative in selected PHC, offering comparable oncological outcomes while preserving functional liver volume despite its technical complexity.