Short-term and long-term clinical outcomes of combined caudate lobectomy for intrahepatic cholangiocarcinoma involving the hepatic hilus: a propensity score analysis

Background: There was a dearth of reliable research on the clinical value of combined caudate lobectomy in intrahepatic cholangiocarcinoma involving the hepatic hilus. We aimed to compare the short-term and long-term outcome of combined versus non-combined caudate lobectomy in patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma involving the hepatic hilus. Methods This single center retrospective cohort study of patients with hilar cholangiocarcinoma was conduct from January 2007 to December 2021. Patients who underwent radical re-resection were enrolled. The short-term and long-term clinical outcomes of the groups were compared before and after propensity score matching. Result A total of 282 patients were included. There was no statistically significant difference in perioperative clinical outcomes between CL (caudate lobectomy) group and non-CL group before and after PSM. Patients who received CL had significantly longer OS before and after PSM (p = 0.007, before PSM; p = 0.033, after PSM), compared to those in the non-CL group. As for DFS, CL group was associated with improved DFS before and after PSM (p < 0.001, before PSM; p = 0.019, after PSM), compared with non-CL group following the curative-intent resection. Conclusion Combined caudate lobectomy (CL) would improve the long-term survival for patients with intrahepatic cholangiocarcinoma involving the hepatic hilus. The postoperative complications of combined CL group were comparable to that of non-CL group, indicating that CL would not worsen postoperative survival. Therefore, radical surgical resection should be actively performed in these patients.