Trends in surgical outcomes for perihilar cholangiocarcinoma: Insights from a Western tertiary center

Introduction: Following the aggressive surgical approach proposed by Japanese authors, the management of perihilar cholangiocarcinoma (PHCC) has evolved over time. Objective: to assess the improvement of surgical outcomes in PHCC patients in a Western tertiary center over the last three decades. Method: 196 PHCC patients underwent curative resection at Verona University Hospital, Italy. Perioperative data were analyzed by comparing early (1995-2004), intermediate (2005-2014), and late (2015-2024) period with the Cochran-Armitage test. Results: 24, 64, and 108 patients underwent surgery in early, intermediate, and late period, respectively. An increased trend in preoperative biliary drainage (38%, 72%, 75%, p = 0.002) portal vein embolization (0%, 6%, 19%, p = 0.003), extended hepatectomies (0%, 13%, 17%, p = 0.040) and vascular resections (4%, 16%, 24%, p = 0.017) was observed. The median number of lymph nodes retrieved increased (3, 9, 9, p < 0.001) while R1 resection decreased (42%, 36%, 34%, p = 0.524). A downward trend of major complications (54%, 39%, 39%, p = 0.274) and 90-day mortality (17%, 8%, 6%, p = 0.152) was reported. Adjuvant therapy rate progressively increased (0%, 39%, 58%, p < 0.001). The 5-year survival was 13%, 29%, 50% in early, intermediate, and late period, respectively (p < 0.001). Conclusion: Advances in PHCC management have led to increased survival and decreased major complications and 90-day mortality.