Long-term results (> 12 years) of surgical treatment of perihilar cholangiocarcinoma: Application of a modified Nagoya approach at a western center

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PURPOSE: To analyze the results of a modified Nagoya approach in perihilar cholangiocarcinoma at a western center. METHODS: The first author trained for one year at Nagoya University. The records of the 53 patients who underwent major hepatobiliary resection between 2001 and 2012 were reviewed. All fundamental principles were strictly applied with following modifications: hepatoduodenal ligament dissection limited to the level cranial to the gastroduodenal artery; 8a-p lymph nodes removed only if macroscopically positive; adjuvant radiotherapy, chemoradiotherapy (CRT) and CRT followed by chemotherapy in selected patients starting in 2007,2009 and 2011 respectively. The results were compared with the 2021 international benchmark values. RESULTS: Twenty-seven patients were men; median (range) age was 54 (29-74). Percutaneous biliary drainage was performed in 45 patients (85%) and portal vein embolization in 8 (15%). Portal vein resection was required in 10 patients (19%). The 90-day mortality was 4% (2/53). Perihepatic fluid infection without an obvious biliary leak was the most frequent complication (42%). The frequencies of liver failure B-C and bile leak were 8% and 12% respectively. The calculated 1,3,5 and 10 -year survival rates were 87%,62%, 41% and 25% respectively. Thirteen patients (25%) survived longer than 10 years: seven had T1 and six had T2a tumors; none had a poorly differentiated tumor, positive surgical margins or lymph node metastasis. CONCLUSIONS: The modified Nagoya approach yielded outcomes similar to 25th percentile values for 90-day mortality, postoperative liver failure B-C and bile leak and benchmark values for 5-year overall survival.

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