ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers
Portal Vein Reconstruction Reduces Textbook Outcome Achievement Following Radical Resection of Hilar Cholangiocarcinoma
Provisionally accepted
- 1The First People's Hospital of Changde City, Changde, China
- 2Army Medical University, Chongqing, China
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Background Hilar cholangiocarcinoma (HCCA) remains a surgically challenging malignancy, often requiring major hepatectomy with vascular resection and reconstruction to achieve R0 resection. Portal vein reconstruction (PVR) enables radical resection in patients with vascular invasion, while its impact on surgical quality, measured by textbook outcome (TO) remains unclear. Methods We retrospectively analyzed 317 HCCA patients who underwent R0 resection at a single tertiary medical center. In this study, TO was defined as the absence of 90-day mortality, readmission within 90 days, post-operative severe comorbidities, postoperative bile leak, post-operative liver failure and intraoperative severe incidents. Epidemiological characteristics, pre-operative examination results, intraoperative features, postoperative comorbidities and survival were compared between PVR (n=62) and non-PVR (n=255) group. Predictors of TO were evaluated using univariate and multivariate logistic regression. Kaplan–Meier curves were used to assessed overall survival (OS) and relapse-free survival (RFS). Results In this study, 113 of 317 patients (35.65%) achieved TO. TO rates were significantly lower in the PVR group (20.97%) compared with the non-PVR group (39.22%, P=0.007). Patients with PVR had higher rates of postoperative infection (73.8% vs 53.6%, P=0.004), bile leakage (32.8% vs 13.5%, P<0.001) and liver failure (8.2% vs 2.0%, P=0.038). After univariate and multivariate analysis, PVR was identified as an independent negative predictor for TO (OR=0.48, P=0.046). Furthermore, Kaplan– Meier analysis indicated significantly worse OS and RFS in both the non-TO and PVR group (all P<0.001). Conclusions PVR is significantly associated with reduced TO achievement and impaired long-term outcomes following R0 resection for HCCA patients. Although PVR remains a necessary approach to achieve curative resection in advanced cases, its impact highlights the need for careful patient selection and optimization of perioperative management to improve clinical outcomes of these patients.
Keywords: Hilar cholangiocarcinoma, Portal vein reconstruction, predictors, prognosis, Textbook Outcome
Received: 17 Nov 2025; Accepted: 06 Feb 2026.
Copyright: © 2026 Li, Li, Chen, Li, Hu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Liu
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