Combined vascular resection and reconstruction for locally advanced perihilar cholangiocarcinoma: A multicenter study

doi:10.3748/wjg.121637

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 28, 2026; 32(44): 121637
Published online Nov 28, 2026. doi: 10.3748/wjg.121637

Combined vascular resection and reconstruction for locally advanced perihilar cholangiocarcinoma: A multicenter study

Xin Gao, Feng Peng, Ju-Kun Su, Yi-Yang Kuai, Jun-Sheng Chen, Xing-Min Yan, Wen-Zheng Liu, De-Yu Li, Chuang Peng, Rui-Zhi He, Yong-Jun Chen

Xin Gao, Feng Peng, Ju-Kun Su, Yi-Yang Kuai, Jun-Sheng Chen, Xing-Min Yan, Wen-Zheng Liu, Rui-Zhi He, Yong-Jun Chen, Division of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China

De-Yu Li, Department of Hepato-Biliary Pancreatic Surgery, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China

Chuang Peng, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China

Co-first authors: Xin Gao and Feng Peng.

Co-corresponding authors: Rui-Zhi He and Yong-Jun Chen.

Author contributions: Gao X and Peng F contributed equally to this work as co-first authors and made comparable and substantial contributions to the conception and design of the study, data collection and verification, statistical analysis, interpretation of the results, and drafting of the manuscript; He RZ and Chen YJ contributed equally to this work as co-corresponding authors and jointly supervised the study, provided critical intellectual input, interpreted the findings, and revised the manuscript critically for important intellectual content; Chen YJ is the corresponding author responsible for all contact and correspondence with the journal during submission, peer review, and publication; Gao X, Peng F, He RZ and Chen YJ designed the research study; Gao X, Peng F, Su JK, Kuai YY, Chen JS, Yan XM and Liu WZ collected and curated the clinical data; Li DY and Peng C contributed multicenter patient data and assisted with data verification; Gao X and Peng F analyzed the data and wrote the manuscript; He RZ and Chen YJ supervised the research and critically revised the manuscript; all authors have read and approved the final manuscript.

AI contribution statement: AI tools, specifically ChatGPT, were used solely for linguistic refinement and formatting assistance. No AI tool was involved in study design, data generation, statistical analysis, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.

Supported by National Natural Science Foundation of China, No. 82573911; and Key Research and Development Program of Hubei Province, No. 2024BCB054.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Tongji Hospital (approval No. TJ-IRB202409061).

Informed consent statement: The requirement for informed consent was waived because of the retrospective and anonymized nature of the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Yong-Jun Chen, PhD, Professor, Division of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. yjchen@tjh.tjmu.edu.cn

Received: March 30, 2026
Revised: June 13, 2026
Accepted: July 9, 2026
Published online: November 28, 2026
Processing time: 185 Days and 13.7 Hours

Abstract

BACKGROUND

Vascular resection may be required to achieve margin-negative resection in advanced perihilar cholangiocarcinoma, but the relative safety and survival impact of hepatic artery resection compared with portal vein resection remain unclear. We hypothesized that hepatic artery resection would not be associated with significantly inferior long-term survival in selected patients treated at experienced centers.

AIM

To evaluate vascular resection outcomes and compare hepatic artery resection with portal vein resection in advanced perihilar cholangiocarcinoma.

METHODS

This multicenter retrospective cohort study included 557 patients with perihilar cholangiocarcinoma treated at three tertiary centers between 2016 and 2020. Overall, 320 underwent curative-intent surgery, including 204 without vascular resection and 116 with vascular resection (51 portal vein resections and 65 hepatic artery resections). Perioperative outcomes and overall survival were compared using Kaplan-Meier analysis, Cox regression, propensity score matching, and restricted mean survival time analysis.

RESULTS

Compared with non-vascular resection, portal vein resection and hepatic artery resection required longer operative times (425/496 minutes vs 314 minutes), greater blood loss (900/900 mL vs 600 mL), and more transfusion (40%/39% vs 14%; all P < 0.001). Major morbidity was higher after vascular resection (non-vascular resection 35.8% vs portal vein resection 45.1% vs hepatic artery resection 44.6%; P = 0.013). Hepatic artery-related events were more frequent after hepatic artery resection than after portal vein resection (20.0% vs 5.9%; P = 0.032). Overall survival did not differ significantly between hepatic artery resection and portal vein resection, including after propensity score matching. Predicted 3-year survival < 0.80 identified shorter restricted mean survival time (9.7 months vs 28.4 months; P < 0.001).

CONCLUSION

Vascular resection is feasible in experienced centers. In this cohort, hepatic artery resection was not associated with worse long-term survival than portal vein resection, despite distinct vascular-specific complication profiles.

Keywords: Perihilar cholangiocarcinoma; Vascular resection and reconstruction; Hepatic artery resection; Portal vein resection; Prognosis

Core Tip: Vascular resection may be required to achieve curative-intent resection in locally advanced perihilar cholangiocarcinoma, but hepatic artery resection remains controversial. In this multicenter cohort, hepatic artery resection was not associated with significantly inferior long-term survival or higher major morbidity compared with portal vein resection, although hepatic artery-associated complications were more frequent after hepatic artery resection. These findings support the selective use of vascular resection in experienced centers and highlight the need for procedure-specific postoperative surveillance.