title: Comparative Analysis of Left- Versus Right-sided Resection in Klatskin Tumor Surgery: can Lesion Side be Considered a Prognostic Factor?
abstract: BACKGROUND
  Achievement of negative margins is the goal of curative intent surgery for hilar cholangiocarcinoma. This study analyzed factors affecting survival in hilar cholangiocarcinoma patients and compared short- and long-term outcomes of left- and right-sided resections.
  
  
  METHODS
  One hundred and five patients out of 124 diagnosed with Klatskin tumors underwent major liver resection. Sixty-one patients underwent right-sided resections (right group), whereas 44 underwent left-sided resections (left group). Perioperative morbidity, perioperative mortality, and overall and disease-free survival were compared between the groups.
  
  
  RESULTS
  Morbidity and mortality were higher in the right group (59 and 8.2%, respectively) than in the left group (38.6 and 2.3%, respectively) (p < 0.005). The most frequent cause of death was liver failure. The R0 rate was 75.4% in the right and 61.4% in the left group. The 5-year survival rate was 42.8% in the right and 35.3% in the left group (p < 0.05). Patients in the left group more frequently developed local recurrence (87 vs. 69% in the right group).
  
  
  CONCLUSIONS
  Lesion side impacts outcome: right resections still cause significant morbidity related to extensive parenchymal sacrifice but are associated with better long-term survival because right hepatic pedicle resection enables better radicality compared with left resections.
authors.affiliation: Hepatobiliary Surgery Division, Ospedale San Raffaele, Via Olgettina 60, Milan, Italy, ratti.francesca@hsr.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.forename: Federica
authors.initials: F
authors.lastname: Cipriani
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Piozzi
authors.forename: Marco
authors.initials: M
authors.lastname: Catena
authors.forename: Michele
authors.initials: M
authors.lastname: Paganelli
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors