A comparison of treatment and outcomes of perihilar cholangiocarcinoma between Eastern and Western centers

Abstract

There were major differences in patient characteristics, treatment strategies, perioperative outcomes and survival between Eastern and Western PHC cohorts. Future studies should focus whether these findings are due to the differences in the treatment or the disease itself.

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

“…Although these results confirm the expected risk-reducing effects of PVE before major liver resection, PVE is only sparsely used in Western series. This is in contrast with the frequent use of PVE in Eastern series; 23 Eastern centers often report the use of PVE in the majority of patients. [23][24][25] The largest single-center series reported use of PVE in 60% of patients and while the rates of liver failure were comparable (32%), mortality was substantially lower at only 2%.…”

“…This is in contrast with the frequent use of PVE in Eastern series; 23 Eastern centers often report the use of PVE in the majority of patients. [23][24][25] The largest single-center series reported use of PVE in 60% of patients and while the rates of liver failure were comparable (32%), mortality was substantially lower at only 2%. 25 This remarkable difference in mortality has been noted across literature 23,26 and could well be due to the higher rates of PVE used in Eastern centers.…”

“…[23][24][25] The largest single-center series reported use of PVE in 60% of patients and while the rates of liver failure were comparable (32%), mortality was substantially lower at only 2%. 25 This remarkable difference in mortality has been noted across literature 23,26 and could well be due to the higher rates of PVE used in Eastern centers. 12,23 The use of PVE extends the time until resection by at least 3-6 weeks in order to allow sufficient growth of the anticipated remnant liver.…”

“…The matched cohorts were equal in all preoperative and operative variables, including the baseline FLRV share, which increased a median of 7 percentage points after PVE. The increase in true remnant liver volume after PVE was 42% (18-59) in a median of 22 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) days. The use of PVE was associated with reductions in liver failure (from 36% to 8%; 4.4-fold reduction) and biliary leakage (from 35 to 10%; 3.5-fold reduction), and a decrease in 90-day mortality (from 18 to 7%; 2.6-fold reduction).…”

ASO Author Reflections: Essential to Reduce Adverse Outcomes in Perihilar Cholangiocarcinoma Surgery—Portal Vein Embolization

“…2 However, the golden standard preoperative procedure to reduce liver failure and mortality-portal vein embolization-is sparsely used in Western centers for patients with perihilar cholangiocarcinoma. 3,4 This is in contrast to Eastern centers, where application of portal vein embolization is liberal and mortality rates are lower. 3…”