Preoperative factors predicting outcomes in patients with suspected perihilar cholangiocarcinoma referred for curative resection- a single-center 10-year experience.

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-12-21 DOI:10.1007/s00423-024-03583-7

H A Al-Saffar, P N Larsen, N Schultz, T S Kristensen, D E Renteria, L A Knøfler, H C Pommergaard

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引用次数: 0

Abstract

Purpose: Perihilar cholangiocarcinoma (pCCA) is a rare malignancy requiring resection of extrahepatic bile ducts with or without hepatectomy. Prognostic models for post-operative outcomes in pCCA are unusable in pre-operative decision-making as most are based on post-operative variables. Additionally, no pre-operative models include futile laparotomy or benign hilar stenosis (BHS) as possible outcomes. We investigated pre-operative predictive factors for non-resectability, disease-free survival (DFS), and overall survival (OS), in patients referred for resection of suspected pCCA.

Methods: Patients with suspected pCCA evaluated at multidisciplinary team (MDT) conference and referred for curative resection at Rigshospitalet, from 2013-2023. Outcomes were preoperative factors related to OS, DFS and non-resectability.

Results: Ninety-three patients with suspected pCCA were considered resectable at MDT, of which 84 (90.3 %) were confirmed pCCA. Nineteen (20.4 %) with pCCA were non-resectable. Patients with non-resectable pCCA had higher pre-operative p-bilirubin and ECOG-performance status (ECOG-PS) compared to resected pCCA and BHS (p=0.02 and 0.01). Portal vein embolization (PVE), higher ECOG-PS and elevated p-bilirubin were associated with worse OS in patients with pCCA undergoing surgical exploration [(HR 2.45 (95% CI 1.32-4.56), p=0.004), (HR 2.32 (95% CI 1.30-4.09), p=0.004) and (HR 2.03 (95% CI 1.17-3.51), p=0.01), respectively]. PVE and larger tumor size were associated with poorer DFS [HR 3.29 (95 % CI 1.64- 6.60), p=0.001) and (HR 1.02 (95% CI 1.00-1.04), p=0.003) respectively].

Conclusion: Poor ECOG-PS, PVE, elevated p-bilirubin and larger tumor size were associated with adverse survival in patients with pCCA undergoing surgical exploration. Non-resectable pCCA were associated with higher rates of elevated p-bilirubin and larger tumor size.

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术前因素预测疑似肝门周围胆管癌患者行根治性切除的预后-一项10年单中心研究

目的：肝门周围胆管癌（pCCA）是一种罕见的恶性肿瘤，需要肝外胆管切除或不切除肝。pCCA术后预后模型在术前决策中是不可用的，因为大多数是基于术后变量。此外，没有术前模型包括无效剖腹手术或良性肺门狭窄（BHS）作为可能的结果。我们调查了术前不可切除性、无病生存期（DFS）和总生存期（OS）的预测因素，这些患者接受了疑似pCCA的切除。方法：2013-2023年，在Rigshospitalet进行多学科小组（MDT）会议评估并转诊的疑似pCCA患者进行根治性切除术。结果为术前OS、DFS和不可切除性相关因素。结果：93例疑似pCCA患者经MDT可切除，其中84例（90.3%）确诊为pCCA。19例（20.4%）pCCA不可切除。与切除的pCCA和BHS相比，不可切除的pCCA患者术前p-胆红素和ecog -性能状态（ECOG-PS）更高（p=0.02和0.01）。门静脉栓塞（PVE）、ECOG-PS升高和p-胆红素升高与行手术探查的pCCA患者的OS恶化相关（HR 2.45 （95% CI 1.32-4.56), p=0.004）、HR 2.32 （95% CI 1.30-4.09), p=0.004）和HR 2.03 (95% CI 1.17-3.51), p=0.01）。PVE和较大肿瘤大小与较差的DFS相关[HR分别为3.29 (95% CI 1.64 ~ 6.60), p=0.001)和1.02 (95% CI 1.00 ~ 1.04), p=0.003)]。结论：pCCA手术探查患者ECOG-PS差、PVE、p-胆红素升高、肿瘤体积增大与生存不良相关。不可切除的pCCA与较高的p胆红素升高率和较大的肿瘤大小相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.