Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma

Keulen, Anne-Marleen van; Buettner, Stefan; Besselink, Marc G.; Busch, Olivier R.; Gulik, Thomas M. van; IJzermans, Jan N.M.; Jonge, Jeroen de; Polak, Wojciech; Swijnenburg, Rutger-Jan; Koerkamp, Bas Groot; Erdmann, Joris I.; Olthof, Pim B.

doi:10.1016/j.hpb.2021.03.016

Cited by 13 publications

(5 citation statements)

References 42 publications

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“…Advanced age, extent of the liver resection, residual biliary obstruction, and preexisting liver disease play important roles. ASA grades III-IV as well as advanced age are associated with high rates of complications, within the first year after surgery, and are independent risk factors for 90-day mortality [5,11,22]. These numbers show the need to reevaluate the role of parenchyma-preserving techniques in patients who are at high risk for postoperative morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…There was a significant difference in the Charlson comorbidity index, with a median score of 6 (3)(4)(5)(6)(7)(8)(9)(10) in PPH compared to 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) in EXT group (p = 0.015). Although not significant, there was a trend for higher rates of diabetes, hypertension as well as kidney disease in the PPH group compared to EXT.…”

Section: Preoperative Characteristics and Comorbiditiesmentioning

confidence: 96%

“…The adoption of a more radical surgical approach has led to higher rates of R0 resections and improved survival. Despite recent improvements in perioperative optimization and the adoption of hypertrophy concepts, the radical resection procedure incurs elevated rates of morbidity and mortality [3,5,[9][10][11][12]. ASA scores III-IV and advanced age are known to be independent risk factors for 90-day mortality [5,13].…”

Section: Introductionmentioning

confidence: 99%

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Parenchyma-Preserving Hepatectomy in Perihilar Cholangiocarcinoma: A Chance for Critical Patients?

Bröring,

Wagner,

von Hahn

et al. 2024

Visc Med

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Introduction: Surgery for perihilar cholangiocarcinoma (pCCA) is associated with high rates of postoperative morbidity and mortality. Extended liver resection (EXT) increases R0 resection rate and survival; however, patients with high perioperative risk are not suitable for extended resection. This study aimed to compare overall survival and surgical morbidity in patients with extended liver resection and parenchyma-preserving hepatectomy (PPH). Methods: Between January 2010 and November 2020, 113 consecutive patients with pCCA underwent surgery at our institution. Eighty-two patients were resected in curative intent. Sixty-four patients received extended liver resection, and 18 patients PPH. Outcomes of resections were evaluated. Results: There was no significant difference in overall survival in patients with PPH compared to extended liver resection (log-rank p = 0.286). Patients with PPH experienced lower rates of postoperative morbidity and mortality. There was no case of in-house mortality in PPH-resected patients compared to 10 cases (16%) in patients that received EXT (p = 0.073). Conclusion: PPH shows similar overall survival with lower rates of postoperative morbidity and mortality. Our findings support the role of a PPH, in selected patients with pCCA, that are not suitable for extended resection due to increased perioperative risk.

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Section: Discussionmentioning

confidence: 99%

Section: Preoperative Characteristics and Comorbiditiesmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Parenchyma-Preserving Hepatectomy in Perihilar Cholangiocarcinoma: A Chance for Critical Patients?

Bröring,

Wagner,

von Hahn

et al. 2024

Visc Med

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“…In the literature, 90-day mortality rates are 1.5–4-fold higher after right- compared with left-sided liver resection for pCCA. 9 , 11 , 27 Most deaths (about 90%) after surgery for pCCA are due to liver failure. 27 On average, the right hemi-liver is twice as large as the left hemi-liver.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 11 , 27 Most deaths (about 90%) after surgery for pCCA are due to liver failure. 27 On average, the right hemi-liver is twice as large as the left hemi-liver. After an extended right hemi-hepatectomy, only segments 2 and 3 remain.…”

Section: Discussionmentioning

confidence: 99%

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Olthof,

Erdmann,

Alikhanov

et al. 2024

Ann Surg Oncol

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Background A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. Methods Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy—left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). Results Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27–34) after left and 23 months (95% CI 20–25) after right liver resection (p < 0.001), and 33 months (95% CI 28–38), 27 months (95% CI 23–32), 25 months (95% CI 21–30), and 21 months (95% CI 18–24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. Conclusions A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.

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Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review

Lopez-Lopez,

Gongora,

Miura

et al. 2024

Langenbecks Arch Surg

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Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma

Cited by 13 publications

References 42 publications

Parenchyma-Preserving Hepatectomy in Perihilar Cholangiocarcinoma: A Chance for Critical Patients?

Parenchyma-Preserving Hepatectomy in Perihilar Cholangiocarcinoma: A Chance for Critical Patients?

Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review

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