The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma

Ratti, Francesca; Marino, Rebecca; Catena, Marco; Pascale, Marco Maria; Buonanno, Silvia; Cobelli, Francesco De; Aldrighetti, Luca

doi:10.1007/s13304-023-01589-2

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…Two studies have analyzed the role of PNI in short-term and long-term outcomes after curative-intent resection for cholangiocarcinoma, demonstrating how a PNI less than 40 is an independent risk factor for severe complication and is correlated to a worse overall survival 38 , 39 . Moreover, a recent study has demonstrated that a PNI less than 40 is a risk factor for failure to rescue in PHC surgery 40 . These findings are in line with present results, reporting high PNI as an independent predictor of TO-achievement.…”

Section: Discussionmentioning

confidence: 99%

Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study

Clocchiatti,

Marino,

Ratti

et al. 2023

International Journal of Surgery

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Background: Definition of Textbook Outcome (TO), defined as a single indicator combining the most advantageous short-term outcomes, is still lacking for Perihilar Cholangiocarcinoma (PHC). The primary endpoint of the present study is to analyse the rate of achievement of a disease-specific textbook outcome for peri-hilar cholangiocarcinoma within a high volume tertiary referral center. Secondary endpoints are to identify predictive factors of TO achievement and to analyze the impact of achieving textbook outcome on long-term results. Methods: Between 2010 and 2022, a total of 237 patients undergoing combined liver and biliary resection for PHC at tertiary referral center were included. Disease-specific TO were defined as: no 90-days mortality, no postoperative complications, no readmission, no intraoperative transfusions and R0 margins. A logistic regression model was developed to identify predictors associated with TO achievement. Kaplan-Meier curves were designed to determine TO’s impact on survival. Results: TO was achieved in 60 (25.3%) patients. At multivariate logistic regression, preoperative biliary drainage (OR 2.90 (1.13 – 3.40), P=0.026), high prognostic nutritional index (OR 7.11 (6.71 – 9.43), P=0.007) and minimally-invasive approach (OR 3.57 (2.31 – 3.62), P=0.013) were identified as independent predictors of TO. High ASA score (OR 0.38 (0.17 – 0.82), P=0.013) decreased the odds of TO. A significant improvement in both overall survival and disease-free survival was associated to TO fulfilment. Conclusion: Since the achievement of textbook outcome correlates with better disease-free and overall survival, every effort should be made to ameliorate modifiable aspects prior to surery: management within referral centers with dedicated experience in biliary tract cancer and preoperative optimization protocol may positively contribute to improve postoperative outcomes, increasing the chance to obtain TO. Moreover, the implementation of advanced minimally invasive programs plays as well.

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Section: Discussionmentioning

confidence: 99%

Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study

Clocchiatti,

Marino,

Ratti

et al. 2023

International Journal of Surgery

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“…The standard preoperative assessment has been described elsewhere [15,16]. Computed tomography and magnetic resonance cholangiopancreatography were conducted for all patients.…”

Section: Preoperative Workupmentioning

confidence: 99%

Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy?

Marino,

Ratti,

Della Corte

et al. 2023

Cancers

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Purpose: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE). Methods: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T1, 10 days post-procedural) and late (T2, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts. Results: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m2 vs. 2.46 ± 0.64%/min/m2, p = 0.041; 27.32 ± 16.86%/week (T1) vs. 15.71 ± 9.82%/week (T1) p < 0.001; 17.19 ± 9.88%/week (T2) vs. 9.89 ± 14.62%/week (T2) p = 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques. Conclusions: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates.

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“…Despite technical and clinical advances, this field of hepatopancreatobiliary (HPB) surgery continues to be burdened by unrestrained surgical risks. 2 Lowering postoperative complication rates is a pressing goal to exploit the benefits of the aggressive surgical resection needed. The authors applied a spline regression model to prove the existing association between high aBL and increased CCI and concluded that a primary goal inferior to 10 ml/kg blood losses should be achieved to effectively reduce overall CCI.…”

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confidence: 99%

Comment on “The Goal of Intraoperative Blood Loss in Major Hepatectomy Resection for Perihilar Cholangiocarcinoma Saving Patients From a Heavy Complication Burden”

Ratti,

Marino,

Aldrighetti

2024

Annals of Surgery Open

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The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma

Cited by 5 publications

References 39 publications

Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study

Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study

Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy?

Comment on “The Goal of Intraoperative Blood Loss in Major Hepatectomy Resection for Perihilar Cholangiocarcinoma Saving Patients From a Heavy Complication Burden”

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