Results from the european survey on preoperative management and optimization protocols for PeriHilar cholangiocarcinoma.

Journal

HPB : the official journal of the International Hepato Pancreato Biliary Association

ISSN: 1477-2574

Titre abrégé: HPB (Oxford)

Pays: England

ID NLM: 100900921

Informations de publication

Date de publication:
Nov 2023

Historique:

received: 30 12 2022

revised: 24 05 2023

accepted: 21 06 2023

pubmed: 6 8 2023

medline: 6 8 2023

entrez: 5 8 2023

Statut: ppublish

Résumé

Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe. 61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols' application. The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups' stratification. The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols' application.

RESULTS RESULTS

The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups' stratification.

CONCLUSION CONCLUSIONS

The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes.

Identifiants

DOI: 10.1016/j.hpb.2023.06.013 PMID: 37543473

pubmed: 37543473

pii: S1365-182X(23)00568-3

doi: 10.1016/j.hpb.2023.06.013

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1302-1322

Investigateurs

Robert Sutcliffe (R)

Pim Olthof (P)

Andrea Ruzzenente (A)

Florin Botea (F)

Enrico Gringeri (E)

Fabian Bartsch (F)

Nadia Russolillo (N)

Carlo Sposito (C)

Matteo Serenari (M)

Francesco Ardito (F)

Jonathan Garnier (J)

Asmund Fretland (A)

Arpad Ivanecz (A)

Olivier Scatton (O)

Andrii Lukashenko (A)

Santi L Ben (SL)

Miguel A Lopez Bravo (MA)

Ajith Siriwardena (A)

Marc Schiesser (M)

Elio Jovine (E)

Bas G Koerkamp (BG)

Olivier Soubrane (O)

Cornelis H Dejong (CH)

Fabrice Muscari (F)

Andre Trudnikov (A)

Ville Sallinen (V)

Par Sandstrom (P)

Giedrius Barauskas (G)

Jiri Pudil (J)

Bergthor Bjornsson (B)

Lilian Schwarz (L)

Erik Schadde (E)

Thomas Gruenberger (T)

Fernando Rotellar (F)

Dervenis Christos (D)

Vladislav Treska (V)

David Fuks (D)

Jan Schmidt (J)

Fatih M Can (FM)

Fernando P Aranda (FP)

Michal Solecki (M)

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of interest None to declare.