Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Abstract

Purpose The concept of “textbook outcome” (TO) as composite quality measure depicting the ideal surgical has not yet been defined for patients undergoing major hepatectomy (MH) for perihilar cholangiocarcinoma (PHC). This study sought to propose a uniform definition through a systematic literature review as well as to identify patient- or procedure-related factors influencing TO. Methods In this retrospective study, we analyzed all patients undergoing MH for PHC at our department between January 2005 and August 2019. After conducting a systematic literature search, we defined TO as the absence of 90-day mortality and major complications, no hospital readmission within 90 days after discharge, and no prolonged hospital stay (<75. percentile). A binary logistic regression analysis was performed to identify factors influencing TO. Results Of 283 patients, TO was achieved in 67 (24%) patients. Multivariate analysis revealed that preoperative biliary drainage was associated with a decreased (OR= 0.405, 95% CI: 0.194–0.845, p=0.016) and left-sided-resection (OR= 1.899, 95% CI: 1.048–3.440, p=0.035) with increased odds for TO. Overall survival (OS) and DFS (disease-free survival) did not differ significantly between the outcome groups (OS: p=0.280, DFS: p=0.735). However, there was a trend towards better overall survival, especially in the late course with TO. Conclusion Our analysis proposed a uniform definition of TO after MH for PHC. We identified left hepatectomy as an independent factor positively influencing TO. In patients where both right- and left-sided resections are feasible, this underlines the importance of a careful selection of patients who are scheduled for right hepatectomy.

Editorial on “Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter?”

“…These data are very interesting, but need to be considered in a larger overall context. Overall short-and long-term outcomes are well in line with previous analyses (8,11,12). However, some points differ from previous analyses.…”

Textbook Outcomes After Open Live Donor Right Hepatectomy and Open Right Hepatic Lobectomy for Cancer in 686 patients

“…TOs for patients with cholangiocarcinoma have been found to be worse than the general population of hepatectomy patients, as Merath et al 11 reported that only 25.5% of patients who underwent liver resection for intrahepatic cholangiocarcinoma achieved a TO, but their dropout rate was significantly influenced by prolonged hospital stay, which we did not include among the criteria of a TO. Benzing et al 23 also reported a low rate of TO in 24% of patients who underwent major hepatectomy for perihilar cholangiocarcinoma and they found that right hepatic lobectomy patients had a lower chance to achieve a TO compared with left hepatectomy. Finally, the laparoscopic approach to right hepatic lobectomy seems to be associated with a significantly lower chance to achieve a TO, as Hobeika et al 17 reported a 23.8% rate of TO, which is approximately half of the TO rate of the open approach, as reported by us in this study and Tsilimigras et al 12 previously.…”

“…We selected these 7 parameters based on studies published in the literature, and also based on what we felt were most clinically meaningful. [9][10][11][12]17,[22][23][24] For example, we did not use ICU LOS as a criterion, as all of the live donor right hepatectomy cases are routinely admitted to the ICU in our institution, while the cancer patients are admitted selectively. Instead, we selected the measure of an urgent unplanned postoperative transfer (eg, condition "C") from the floor to the ICU as a failure of a TO, as that indicates a clinical deterioration of the patient who requires ICU care.…”

Prognostic influence for hilar cholangiocarcinoma and comparisons of prognostic values of Mayo staging and TNM staging systems

“…Among them, radical resection (21 months) was significantly better than palliative resection (13.8 months) and palliative biliary drainage (8.7 months) in median survival, which is the same as other studies. [19][20][21] Because Bismuth-Corlette typing is simple to operate, it is widely used in clinical practice to guide surgical treatment, improve R0 resection rate, and achieve the purpose of prolonging survival. However, some foreign scholars used the Bismuth-Corlette typing criteria to classify 230 patients with resectable HCCA.…”