Predictive model for the intraoperative unresectability of hilar cholangiocarcinoma: Reducing futile surgical exploration

Abstract

Introduction Surgical exploration is widely performed in hilar cholangiocarcinoma (HCCA), but the intraoperative resectability rate is only 60%-80%. Exploration substantially increases pain and mental stress, and the costs and length of hospital stay are considerably increased. Identifying preoperative risk factors associated with unresectability could decrease unnecessary exploration. Materials and methods In total, 440 HCCA patients from multiple centers were enrolled. Those receiving surgical exploration were divided into the resected and unresected groups. Morphological variables including Bismuth classification, lymph node metastasis and vessel invasion were obtained from radiological exams. Logistic regression for the training cohort was used to identify risk factors for unresectability, and a nomogram was constructed to calculate the unresectability rate. A calibration curve assessed the power of the nomogram. Results Among 311 patients receiving surgical exploration, 45 (14.7%) were unresectable by intraoperative judgment. Compared with the resected group, unresected patients had similar costs (p = 0.359) and lengths of hospital stay (p = 0.439). Multivariable logistic regression of the training cohort (235 patients) revealed that CA125, Bismuth-Corlette type IV, lymph node metastasis and hepatic artery invasion were risk factors for unresectability. Liver atrophy (p = 0.374) and portal vein invasion (p = 0.114) were not risk factors. The nomogram was constructed based on the risk factors. The concordance index (C-index) values of the calibration curve for predicting the unresectability rate of the training and validation (76 patients) cohorts were 0.900 (95% CI, 0.835–0.966) and 0.829 (95% CI, 0.546–0.902), respectively. Conclusion Analysis of preoperative factors could reveal intraoperative unresectability and reduce futile surgical explorations, ultimately benefiting HCCA patients.

Vascular invasion and lymph node metastasis mediate the effect of CA242 on prognosis in hilar cholangiocarcinoma patients after radical resection

“…In previous report, vascular invasion, including hepatic artery and portal vein invasion, and lymph node metastasis played critical roles in assessing the surgical resectability, excision extension and clinical prognosis ( 12 ). However, the accuracy of preoperative imaging technologies like CT or MRI to evaluate the situation of major vessels and lymph nodes was still limited, which was largely determined by pathological examination postoperatively ( 13 ).…”

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

“…With the advancement of imaging and hepatobiliary surgery technology, the surgical resection rate and prognosis of the disease have been significantly improved. The concept of surgical treatment for the disease tends to expand the scope of resection and to achieve the effect of radical tumor resection [ 5 ]. 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 ].…”