Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Spolverato, Gaya; Yakoob, Mohammad Yawar; Kim, Yuhree; Alexandrescu, Sorin; Marques, Hugo P.; Lamelas, Jorge; Aldrighetti, Luca; Gamblin, T. Clark; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Marsh, J. Wallis; Pawlik, Timothy M.

doi:10.1002/cncr.29419

Cited by 72 publications

(62 citation statements)

References 41 publications

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“…Some authors had reported an improved survival over time for the past few years, however, this might be attributed to improved non-surgical therapy or more careful selection of candidates for surgical resection [74] . Postoperative complications were found to be independent predictors of worse long-term outcomes (hazard ratio [HR], 1.64; 95% CI, 1.30-2.08), and the outcome worsens with increased severity of the complications [75] . Outcomes of ICC depend on disease stage (especially the presence or absence of node involvements and vascular invasion) and status of surgical margins, rather than size [72] .…”

Section: Outcomes After Resectionmentioning

confidence: 99%

“…Patients who had a positive-margin (R1) resection had higher risk of recurrence (HR, 1.61; 95% CI, 1.15-2.27) and shorter overall survival (OS) (1.54; 1.12-2.11) than those with R0 resection [80] . Stage-stratified 5-year survivals according to the 7 th edition of the AJCC staging system were 32% for all patients enrolled, 62% for stage I (T1N0), 27% for stage II (T2N0) and 14% for stage III (T3N0, T1-3, N1) in a French study of 163 patients undergoing potentially curative surgery [73] .…”

Section: Outcomes After Resectionmentioning

confidence: 99%

“…First recurrence site was intrahepatic only (59.8%), extrahepatic only (14.5%), or both intra-and extrahepatic (25.7%) [83] . The demonstrated risk factors for recurrence included histologically-positive margins and node involvement.…”

Section: Page 12 Of 36mentioning

confidence: 99%

“…The demonstrated risk factors for recurrence included histologically-positive margins and node involvement. Recurrent ICCs are associated with worse outcome, among those patients, median survival from the time of the recurrence was 11.1 months with the treatment of different modalities, the median survival of patients undergoing resection of recurrent tumor was 26.7 months [83] . A nomogram is a good tool to predict survival after resection.…”

Section: Page 12 Of 36mentioning

confidence: 99%

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Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management

2016

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Section: Outcomes After Resectionmentioning

confidence: 99%

Section: Outcomes After Resectionmentioning

confidence: 99%

Section: Page 12 Of 36mentioning

confidence: 99%

Section: Page 12 Of 36mentioning

confidence: 99%

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Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management

2016

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“…[14–17] Most EHBM require a major surgical procedure, which can involve a liver resection, removal of the extrahepatic biliary tree, or a pancreatoduodenectomy. [1] Peri-operative outcomes following these extensive operations can be associated with considerable morbidity, with post-operative complications as high as 30–40% in many centers.…”

Section: Introductionmentioning

confidence: 99%

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Buettner

Ethun

Poultsides

et al. 2017

Journal of Gastrointestinal Surgery

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Background Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extra-hepatic bilary malignancies (EHBM). Methods Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results 728 patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection liver resection was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n=70, 9.6%) or formation of an abscess in the operative bed (n=91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p=0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p=0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p=0.008). Conclusion SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of post-operative SSI was adversely associated with long-term survival.

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Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

et al. 2021

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IMPORTANCE Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR).OBJECTIVE To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis.DESIGN, SETTING, AND PARTICIPANTS Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.MAIN OUTCOMES AND MEASURES Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin.RESULTS A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P < .001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P = .02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P = .002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P = .001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P < .001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P < .001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P = .01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P = .02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P = .004) were associated with a worse TOLS rate. CONCLUSIONS AND RELEVANCEIn this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

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Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Cited by 72 publications

References 41 publications

Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management

Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

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