Associating portal vein ligation and liver partition for staged hepatectomy for perihilar cholangiocarcinoma can lead to favorable survival that is comparable to existing radical surgical approaches such as 1-stage hepatectomy and liver transplantation, according to a new study published in Surgery.

“This study highlights that the critical attitude toward associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma needs to be revised,” the study authors said. They added that further studies are needed to analyze the short- and long-term outcomes of the approach compared to current standards of care for the disease.

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Associating portal vein ligation and liver partition for staged hepatectomy initially yielded poor results and was therefore not indicated for the treatment of perihilar cholangiocarcinoma. However, recent studies have reported better outcomes.

In the present study, a team of researchers led by Henrik Petrowsky, MD, from the Department of Surgery and Transplantation at the Swiss Hepatopancreaticobiliary and Transplant Center at University Hospital Zürich in Switzerland, analyzed factors that may be related to these improved outcomes.

The team collected information about the recent experiences of different centers performing the procedure and analyzed the results. 

They found that in the 39 patients who underwent the procedure at 8 different centers between 2010 and 2020, the median future liver remnant increase was 58.7% with a median interstage interval of 13 days.

Post-stage 1 biliary leaks occurred in 7.7% of patients, while post-stage 2 biliary leaks occurred in 15% of patients.

Grade 3 or higher complications occurred in 23% of patients after stage 1 biliary leaks and 23% of patients with stage 2 biliary leaks, of whom 7.7% died (2 patients).

The 1-year survival of the patients was 92%, while their 3-year survival was 69% and their 5-year survival was 55%. 

Patients who underwent additional vascular resection and those who had lymph node positivity had poor survival. Patients who were lymph node negative, on the other hand, had excellent survival with 1-, 3-, and 5-year survival rates of 86%, 86%, and 86%, respectively.


Balci D, Nadalin S, Mehrabi A, et al. Revival of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma: an international multicenter study with promising outcomes. Surgery. Published online March 22, 2023. doi:10.1016/j.surg.2023.02.008