SURGICAL OUTCOMES OF NON-BENCHMARK PERIHILAR CHOLANGIOCARCINOMA: A MULTICENTER STUDY FROM HIGH-VOLUME CENTERS IN JAPAN t.sugiura@scchr.jp

 

SURGICAL OUTCOMES OF NON-BENCHMARK PERIHILAR CHOLANGIOCARCINOMA: A MULTICENTER STUDY FROM HIGH-VOLUME CENTERS IN JAPAN

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Japan

Oral or Poster

Benchmark (BM) criteria have been proposed to standardize outcomes in complex hepatopancreatobiliary surgery, but they often exclude patients with significant comorbidities or technically demanding procedures. As a result, non-benchmark (non-BM) patients with perihilar cholangiocarcinoma (PHC), who represent a majority in real-world practice, remain underrepresented in the literature.

Between 2014 and 2018, a total of 648 patients underwent resection for PHC at six high volume centers in Japan. Of these, 412 patients (64 %) were categorized as non BM. Perioperative and oncologic outcomes were analyzed and compared with benchmark thresholds previously reported in the literature. Non BM cases were further stratified into surgical, medical, and dual subgroups for subgroup analysis.

The median operative time (644 minutes), blood loss (1185 mL), and postoperative hospital stay (31 days) exceeded BM thresholds. Nevertheless, most postoperative outcomes, including Grade B/C post-hepatectomy liver failure (16%), bile leakage (22.8%), and 30-day mortality (2.9%), remained within benchmark reference values. The median overall survival was 44.4 months, with 1-, 3-, and 5-year survival rates of 85.8%, 55.0%, and 35.4%, respectively. Subgroup analysis revealed decreasing survival with increasing complexity: 5-year survival rates were 50.5% in medical, 34.1% in surgical, and 15.4% in dual non-BM patients. Notably, left hepatic trisectionectomy was associated with the highest mortality (9.5%) among all

Despite increased surgical complexity and patient-related risk factors, non-BM PHC patients can achieve acceptable perioperative and long-term outcomes when treated at experienced, high-volume centers. Stratification by non-BM subgroup provides meaningful prognostic insight and may help guide surgical decision-making in complex PHC cases.