title: Liver resection for perihilar cholangiocarcinoma - why left is sometimes right.
abstract: Left-sided liver resection (LLR) for perihilar cholangiocarcinoma (PHC) may require right hepatic artery (RHA) resection and reconstruction because of its intimate relationship with the biliary confluence. Consequently right-sided resections (RLR) are preferred for Bismuth-Corlette IIIb tumours, and resections avoided in Bismuth-Corlette IV tumours with left lobar atrophy when the RHA is involved by tumour.
  
  
  
  A retrospective analysis of patients with PHC who presented between December 2009 and June 2015.
  
  
  
  Thirty-six patients underwent resection for PHC (23 LLR, 13 RLR). The number of Bismuth-Corlette IV patients undergoing LLR was significantly greater than those undergoing RLR (8/23 vs 0/13, p = 0.032). The need for arterial reconstruction (AR) was significantly greater during LLR than RLR (10/23 vs 0/13, p = 0.006). Postoperative liver dysfunction was greater after RLR (5/13 vs 0/23, p = 0.003), and hospital stay was shorter after LLR (10 vs 15 days, p = 0.013).
  
  
  
  Safe AR increases the ability to perform potentially curative LLR for PHC. This improves the resectability rate for PHC, particularly for Bismuth-Corlette Type IV tumours. The larger liver remnant after LLR results in less postoperative liver dysfunction and shorter hospital stay without increased operating time, blood loss or morbidity.
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Govil
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Bharatan
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Rathnavel
authors.initials: R
authors.lastname: Kanagavelu
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Ilankumaran
authors.initials: I
authors.lastname: Kaliamoorthy
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India.
authors.forename: Mettu S
authors.initials: MS
authors.lastname: Reddy
authors.affiliation: Institute of Liver Surgery & Transplantation, Global Hospital, Chennai, India; Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, Uk. Electronic address: mohamed.rela@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult