{"title":"The role of surgical approach in recovery from extrahepatic cholangiocarcinoma: hemihepatectomy vs. pancreatoduodenectomy.","authors":"Shimpei Otsuka, Teiichi Sugiura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada, Yoshiyasu Kato, Katsuhiko Uesaka","doi":"10.1007/s00423-024-03591-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study compared short- and mid-term outcomes of hemihepatectomy (HH) and pancreatoduodenectomy (PD) in patients with extrahepatic cholangiocarcinoma, focusing on surgical outcomes, body composition, and nutritional status.</p><p><strong>Method: </strong>A retrospective review was conducted to assess short-term outcomes, including operative time, blood loss, complications, and mortality. Body composition and nutritional parameters were analyzed preoperatively and 1 year postoperatively. Multivariate analysis identified factors influencing outcomes.</p><p><strong>Result: </strong>Among 216 patients (HH: n = 94, PD: n = 122), HH was associated with younger age (median 72 vs. 74 years, p = 0.041), longer operative times (p = 0.008), and greater blood loss (p < 0.001) compared to PD. Despite this, HH had fewer severe complications (42.6% vs. 75.4%, p < 0.001), lower rates of pancreatic fistula (5.3% vs. 60.7%, p < 0.001), and shorter postoperative hospital stays (p = 0.002). Mortality occurred in 3 HH patients (3.2%), all of whom underwent right hemihepatectomy, compared to none in PD (p = 0.081). One year postoperatively, HH patients had better preservation of skeletal muscle area (p = 0.139), body fat area (p = 0.319), and hemoglobin levels (p = 0.060) compared to significant declines observed in PD patients (all p < 0.001). Multivariate analysis indicated that HH was independently associated with better preservation of skeletal muscle area (β = 2.58, p < 0.001), body fat area (β = 20.86, p < 0.001), and hemoglobin levels (β = 0.81, p = 0.009) at one year postoperatively.</p><p><strong>Conclusion: </strong>HH was associated with better preservation of physical and nutritional status compared to PD. However, the higher perioperative mortality observed in HH, particularly right hemihepatectomy, necessitates careful consideration of the risks and benefits when selecting the surgical approach for patients with extrahepatic cholangiocarcinoma.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"16"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Langenbeck's Archives of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00423-024-03591-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This study compared short- and mid-term outcomes of hemihepatectomy (HH) and pancreatoduodenectomy (PD) in patients with extrahepatic cholangiocarcinoma, focusing on surgical outcomes, body composition, and nutritional status.
Method: A retrospective review was conducted to assess short-term outcomes, including operative time, blood loss, complications, and mortality. Body composition and nutritional parameters were analyzed preoperatively and 1 year postoperatively. Multivariate analysis identified factors influencing outcomes.
Result: Among 216 patients (HH: n = 94, PD: n = 122), HH was associated with younger age (median 72 vs. 74 years, p = 0.041), longer operative times (p = 0.008), and greater blood loss (p < 0.001) compared to PD. Despite this, HH had fewer severe complications (42.6% vs. 75.4%, p < 0.001), lower rates of pancreatic fistula (5.3% vs. 60.7%, p < 0.001), and shorter postoperative hospital stays (p = 0.002). Mortality occurred in 3 HH patients (3.2%), all of whom underwent right hemihepatectomy, compared to none in PD (p = 0.081). One year postoperatively, HH patients had better preservation of skeletal muscle area (p = 0.139), body fat area (p = 0.319), and hemoglobin levels (p = 0.060) compared to significant declines observed in PD patients (all p < 0.001). Multivariate analysis indicated that HH was independently associated with better preservation of skeletal muscle area (β = 2.58, p < 0.001), body fat area (β = 20.86, p < 0.001), and hemoglobin levels (β = 0.81, p = 0.009) at one year postoperatively.
Conclusion: HH was associated with better preservation of physical and nutritional status compared to PD. However, the higher perioperative mortality observed in HH, particularly right hemihepatectomy, necessitates careful consideration of the risks and benefits when selecting the surgical approach for patients with extrahepatic cholangiocarcinoma.
背景：本研究比较了半肝切除术（HH）和胰十二指肠切除术（PD）治疗肝外胆管癌患者的短期和中期预后，重点关注手术结果、身体成分和营养状况。方法：回顾性评价近期预后，包括手术时间、出血量、并发症和死亡率。术前及术后1年分析体成分及营养指标。多变量分析确定了影响结果的因素。结果：在216例患者（HH: n = 94, PD: n = 122）中，HH与年龄较年轻（中位72 vs. 74岁，p = 0.041）、手术时间较长（p = 0.008）、出血量较大(p)相关。结论：与PD相比，HH与更好地保存身体和营养状况相关。然而，HH的围手术期死亡率较高，尤其是右半肝切除术，因此在选择肝外胆管癌患者的手术入路时需要仔细考虑风险和收益。
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.
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