Introduction : Although major hepatectomy with PD (major HPD) for diffuse perihilar cholangiocarcinoma (HC) is a definitive surgical procedure for potentially curative resection, mortality and morbidity are still high. Therefore, we have performed several kinds of limited hepatectomies with PD (limited HPD) for high-risk patients. The aim of this study is to evaluate the validity of limited HPD for patients with laterally advanced cholangiocarcinoma, who were high risk for undergoing major HPD.

Methods : 22 patients underwent HPD for HC from April 1992 to December 2017. Short and long term outcomes were compared between limited HPD patients (n=9) and major HPD patients (n=13).

Results : Limited HPD patients were significantly older than the major HPD patients (p=0.040). Although 3 patients were dead in hospital in major HPD, no patients were dead in limited HPD. The morbidity, that was over GradeIII in Clavien-Dindo criteria, had no difference between two groups (p=0.495). Histopathological findings showed that the rate of R0 resection was higher in major HPD (69.2%) than in limited HPD (55.5%) although there were no significant difference (p=0.837). Local recurrence rate was low both in major HPD (8.3%) and limited HPD group (0%). 3-year overall survival rate of limited HPD patients was as good as that of major HPD patients (58.3% VS 37.5%, p=0.516).

Conclusions : The short and long outcome of limited HPD was as good as that of major HPD due to avoidance of postoperative liver failure. Limited HPD was an acceptable option for high risk patients such as poor liver function or poor general condition.