Management of hilum infiltrating tumors of the liver: The impact of experience and standardization on outcome.
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms
/ mortality
Disease-Free Survival
Female
Hepatectomy
/ methods
Humans
Klatskin Tumor
/ mortality
Male
Middle Aged
Outcome Assessment, Health Care
Postoperative Complications
/ mortality
Preoperative Care
/ standards
Retrospective Studies
Statistics, Nonparametric
Hilar cholangiocarcinoma
Liver surgery
Monocentric management
Preoperative optimization
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
05
03
2018
revised:
04
07
2018
accepted:
09
07
2018
pubmed:
18
8
2018
medline:
14
6
2019
entrez:
18
8
2018
Statut:
ppublish
Résumé
The primary endpoint of this study was to evaluate the outcome of surgery for perihilar cholangiocarcinoma in a high-volume tertiary referral center. The study population consisted of 196 consecutive patients with histologically confirmed perihilar cholangiocarcinoma-PHC-who were candidates to surgical treatment. Factors affecting postoperative morbidity were evaluated in the whole series (primary endpoint) and after stratification of patients according to the following criteria: (a) perioperative management protocol implementation; (b) monocentric management (secondary endpoint). The postoperative morbidity rate was 51.5% and mortality 4.1%. The most frequent cause of death was postoperative liver failure. At multivariate analysis, factors affecting the risk of morbidity were: side of hepatectomy, liver volume, intraoperative blood loss, preoperative optimization and single-center management. Patients treated according to preoperative optimization protocol, as well as patients with monocentric management experienced a significant reduction of postoperative morbidity. Preoperative optimization and single-center management significantly affected even long term outcome of patients. Despite continuous improvement in the surgical field, hilum-infiltrating tumors still remain associated with therapeutic and management challenges: a correct preoperative management in a tertiary referral center provides a benefit in terms of morbidity and mortality, thus improving long term results.
Sections du résumé
BACKGROUND
The primary endpoint of this study was to evaluate the outcome of surgery for perihilar cholangiocarcinoma in a high-volume tertiary referral center.
METHODS
The study population consisted of 196 consecutive patients with histologically confirmed perihilar cholangiocarcinoma-PHC-who were candidates to surgical treatment. Factors affecting postoperative morbidity were evaluated in the whole series (primary endpoint) and after stratification of patients according to the following criteria: (a) perioperative management protocol implementation; (b) monocentric management (secondary endpoint).
RESULTS
The postoperative morbidity rate was 51.5% and mortality 4.1%. The most frequent cause of death was postoperative liver failure. At multivariate analysis, factors affecting the risk of morbidity were: side of hepatectomy, liver volume, intraoperative blood loss, preoperative optimization and single-center management. Patients treated according to preoperative optimization protocol, as well as patients with monocentric management experienced a significant reduction of postoperative morbidity. Preoperative optimization and single-center management significantly affected even long term outcome of patients.
CONCLUSION
Despite continuous improvement in the surgical field, hilum-infiltrating tumors still remain associated with therapeutic and management challenges: a correct preoperative management in a tertiary referral center provides a benefit in terms of morbidity and mortality, thus improving long term results.
Identifiants
pubmed: 30115572
pii: S1590-8658(18)30817-X
doi: 10.1016/j.dld.2018.07.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
135-141Informations de copyright
Copyright © 2018. Published by Elsevier Ltd.