CLINICOPATHOLOGICAL CHARACTERISTICS AND SURGICAL OUTCOMES OF LIVER RESECTION FOR PROXIMAL BILIARY TUMORS AT A LOW-VOLUME CENTER drrizwankhan@hotmail.com

 

CLINICOPATHOLOGICAL CHARACTERISTICS AND SURGICAL OUTCOMES OF LIVER RESECTION FOR PROXIMAL BILIARY TUMORS AT A LOW-VOLUME CENTER

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Pakistan

Oral or Poster

Proximal biliary tumors, including intrahepatic and perihilar cholangiocarcinomas, as well as gallbladder cancers, present significant management challenges due to their aggressive nature and the complexity of required surgeries. Achieving R0 resection is a critical factor for survival, often necessitating concomitant hepatic resection. Our study aimed to evaluate the clinicopathological characteristics and surgical outcomes of patients with biliary tumors treated at a low-volume center in Pakistan.

A retrospective analysis was conducted of patients at Aga Khan University Hospital between January 2008 and December 2023 who presented with radiological evidence of proximal biliary tumors and underwent concomitant liver resection. Demographic, clinical, and pathological data, and surgical outcomes, were reviewed.

Forty-three patients underwent concomitant liver resection for proximal biliary tumors, with equal gender distribution. Fifty-three percent had comorbidities. Gallbladder adenocarcinoma was the most common indication (62%), followed by hilar cholangiocarcinoma (19%) and xanthogranulomatous cholecystitis (14%). Bismuth IIIA was the most common type of hilar cholangiocarcinoma (50%), and 30% of patients underwent major liver resection. Final histopathology revealed T2N0M0 as the most common stage. Lymph node involvement was observed in 36% of patients, with a mean lymph node yield of 6.8 ± 4 nodes and extra-nodal extension was found in 16% patients. Overall morbidity was 42%, with 25% having Clavien-Dindo grade ≥ III complications. The 90-day mortality rate was 2.3%.

This study demonstrates that hepatic resections for proximal biliary tumors can be performed in low-volume centers with acceptable morbidity and mortality rates with careful patient selection and perioperative care.