To compare the clinical efficacy between limited resection and extended hepatectomy for type Ⅲ and Ⅳ hilar cholangiocarcinoma.

Clinical data of 73 patients with type Ⅲ and Ⅳ hilar cholangiocarcinoma admitted to the Second Affiliated Hospital of Guangzhou Medical University from February 2010 to October 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 47 cases were male and 26 were female, aged (54±6) years on average. According to different surgical procedure, the patients were divided into the limited and extended groups. In limited group, irregular resection of portal region was performed, and hemihepatectomy combined with caudate lobectomy was performed in extended group. The tumor resection rate and incidence of complications were compared between two groups by Chi-square test or Fisher's exact probability test. Survival analysis was conducted with Kaplan-Meier survival curve and Log-rank test.

The tumor resection rate in extended group was 90%(37/41), significantly higher than 53%(17/32) in limited group (χ²=2.650, P<0.05). The incidence of bleeding, infection, bile leakage, pleural effusion and liver failure did not significantly differ between two groups (P>0.05). The 1-, 3-, and 5-year survival rates in extended group were 82%, 38%, and 15%, significantly higher than 58%, 16% and 3% in limited group (χ²=4.869, 4.221, 4.607; P<0.05). The median survival time was 32 months in extended group and 20 months in limited group. The overall survival in extended group was significantly better than that in limited group (χ²=2.825, P<0.05).

Compared with limited resection, extended hepatectomy can improve the tumor resection rate and survival rate of patients with type Ⅲ and Ⅳ hilar cholangiocarcinoma, whereas does not increase the incidence of postoperative complications.