Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

Abstract

BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown. AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA. METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS). RESULTS Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003; RFS: 16.0 mo vs 26.0 mo, respectively, P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, P < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA. CONCLUSION Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.

Impact of perioperative blood transfusion on long-term survival in patients with different stages of perihilar cholangiocarcinoma treated with curative resection: A multicentre propensity score matching study

“…Patients were divided into two groups according to the upper or lower limits of normal of each preoperative laboratory variable. Specifically, the following thresholds were employed: ALT and AST: 40 U/L, INR: 1.15, ALB: 35 g/L, HGB: 120 g/L, and CA 19-9: 37 U/L ( 13 , 14 , 17 ). All postoperative histopathological variables were confirmed by postoperative histopathological examination of tumor or nontumor tissues.…”

“…Curative resection was defined as resection resulting in microscopically clear margins. Curative resection included bile duct resection, biliary reconstruction, hepatectomy, lymph node dissection, and vascular reconstruction for vascular invasion as previously reported (13)(14)(15). Curative resection was performed by experienced surgeons in hepatobiliary surgery in the 3 institutions.…”

“…Extent of hepatectomy was divided into major hepatectomy (three or more resected Couinaud liver segments) and minor hepatectomy (two or less resected Couinaud liver segments). In previous studies, pCCA patients with a tumor size > 3 cm showed poor long-term survival (13,14). As a consequence, 3 cm was used to divide patients into 2 groups.…”

Development and Validation of a Prognostic Model to Predict Recurrence-Free Survival After Curative Resection for Perihilar Cholangiocarcinoma: A Multicenter Study

“…However, it lacks accuracy because AJCC staging lacks many prognostic factors ( 7 ). With the deepening of the studies, most of the factors related to prognosis after curative pCCA resection have been determined, including tumor differentiation, macro- or microvascular invasion, tumor size, lymph node (LN) status, and serum tumor biomarkers ( 8 – 12 ). For LN status, provided that the number of examined lymph nodes (ELNs) is less than 4, prediction systems may falsely indicate negative LN involvement, which was demonstrated to be an independent risk factor for poor oncologic prognosis of pCCA ( 13 – 15 ).…”

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

“…Especially for the common Bismuth type IIIa, IIIb and IV, it is often necessary to combine left and right liver and caudate lobe resection to achieve negative resection margins and achieve the effect of radical tumor resection [ 6 ]. The invasion of surrounding tissues and organs requires combined vascular resection and reconstruction or pancreaticoduodenectomy [ 7 ]. Therefore, the safety and effect of resection of hilar cholangiocarcinoma have been the focus of surgeons.…”