The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy. One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n = 31) or major (n = 31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%). Minor hepatectomy had a significantly shorter operation time (245.42 ± 54.31 vs. 282.16 ± 66.65 min; P = 0.023), less intraoperative blood loss (194.19 ± 149.17 vs. 315.81 ± 256.80 mL; P = 0.022), a lower transfusion rate (4 vs. 11 patients; P = 0.038), more rapid bowel recovery (17.77 ± 10.00 vs. 24.94 ± 9.82 h; P = 0.005), and a lower incidence of liver failure (1 vs. 6 patients; P = 0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8 % vs. 22.6 %; P = 0.648), and 3-year disease-free survival (12.9 % vs. 16.1 %; P = 0.989) were comparable between the groups. In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.

中文翻译：

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小肝切除术联合胆管成形术和胆管空肠吻合术治疗 Bismuth II 肝门部胆管癌：倾向评分匹配分析

Bismuth II 肝门部胆管癌 (HCCA) 的最佳手术方法仍存在争议。本研究比较了小规模肝切除术和大肝切除术的围手术期和肿瘤学结果。回顾性研究 2018 年 1 月至 2022 年 12 月期间接受肝切除术和胆管空肠吻合术的 117 例 Bismuth II HCCA 患者。倾向评分匹配创建了一个由 62 名接受小规模肝切除术 (n = 31) 或大规模肝切除术 (n = 31) 的患者组成的队列。比较各组之间的围手术期结果、并发症、生活质量和生存结果。连续数据表示为平均值±标准差，分类变量表示为n (%)。小规模肝切除术的手术时间显着缩短（245.42±54.31 vs. 282.16±66.65 min；P = 0.023），术中失血量较少（194.19±149.17 vs. 315.81±256.80 mL；P = 0.022），输血率较低（4与 11 名患者相比；P = 0.038），肠道恢复更快（17.77 ± 10.00 与 24.94 ± 9.82 小时；P = 0.005），并且肝衰竭发生率较低（1 名患者与 6 名患者；P = 0.045）。伤口感染、胆漏、出血、肺部感染、腹腔积液和并发症发生率组间无显着差异。术后实验室检查值、住院时间、生活质量评分、3 年总生存率（25.8 % 与 22.6 %；P = 0.648）和 3 年无病生存率（12.9 % 与 16.1 %；P = 0.989）组间具有可比性。在这项倾向评分匹配分析中，选定的 Bismuth II HCCA 患者的小规模肝切除术和大范围肝切除术之间的总生存期和无病生存期具有可比性。小规模肝切除术与更短的手术时间、更少的术中失血、更少的输血需求、更快的肠道恢复以及更低的肝衰竭发生率相关。此外，这一发现还需要大规模、多中心、前瞻性随机对照试验和长期随访的证实。