Minor hepatectomy combined with cholangioplasty and cholangiojejunostomy for Bismuth II hilar cholangiocarcinoma: a propensity score matching analysis

Background The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy. Materials and methods One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n=31) or major (n=31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%). Results Minor hepatectomy had a significantly shorter operation time (245.42±54.31 vs. 282.16±66.65 min; P=0.023), less intraoperative blood loss (194.19±149.17 vs. 315.81±256.80 mL; P=0.022), a lower transfusion rate (4 vs. 11 patients; P=0.038), more rapid bowel recovery (17.77±10.00 vs. 24.94±9.82 h; P=0.005), and a lower incidence of liver failure (1 vs. 6 patients; P=0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8% vs. 22.6%; P=0.648), and 3-year disease-free survival (12.9% vs. 16.1%; P=0.989) were comparable between the groups. Conclusion In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.