TY - JOUR
T1 - A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma
AU - Gaspersz, Marcia P.
AU - Buettner, Stefan
AU - Roos, Eva
AU - van Vugt, Jeroen L. A.
AU - Coelen, Robert J. S.
AU - Vugts, Jaynee
AU - Wiggers, Jimme K.
AU - Allen, Peter J.
AU - Besselink, Marc G.
AU - Busch, Olivier R. C.
AU - Belt, Eric J.
AU - D’Angelica, Michael I.
AU - DeMatteo, Ronald P.
AU - de Jonge, Jeroen
AU - Kingham, T. Peter
AU - Polak, Wojciech G.
AU - Willemssen, François E. J. A.
AU - van Gulik, Thomas M.
AU - Jarnagin, William R.
AU - Ijzermans, Jan N. M.
AU - Groot Koerkamp, Bas
PY - 2018
Y1 - 2018
N2 - Background: Patients with resectable perihilar cholangiocarcinoma (PHC) on imaging have a substantial risk of metastatic or locally advanced disease, incomplete (R1) resection, and 90-day mortality. Our aim was to develop a preoperative prognostic model to predict surgical success, defined as a complete (R0) resection without 90-day mortality, in patients with resectable PHC on imaging. Study Design: Patients with PHC who underwent exploratory laparotomy in three tertiary referral centers were identified. Multivariable logistic regression was performed to identify preoperatively available prognostic factors. A prognostic model was developed using data from two European centers and validated in one American center. Results: In total, 671 patients with PHC underwent exploratory laparotomy. In the derivation cohort, surgical success was achieved in 102 of 331 patients (30.8%). No resection was performed in 176 patients (53.2%) because of metastatic or locally advanced disease. Of the 155 patients (46.8%) who underwent a resection, 38 (24.5%) had an R1-resection. Of the remaining 117 (35.3%), 15 (12.8%) had 90-day mortality. Independent poor prognostic factors for surgical success were identified, and a preoperative prognostic model was developed with a concordance index of 0.71. External validation showed good concordance (0.70). Conclusion: Surgical success was achieved in only 30% of patients with PHC undergoing exploratory laparotomy and could be predicted by age, cholangitis, hepatic artery involvement, lymph node metastases, and Blumgart stage.
AB - Background: Patients with resectable perihilar cholangiocarcinoma (PHC) on imaging have a substantial risk of metastatic or locally advanced disease, incomplete (R1) resection, and 90-day mortality. Our aim was to develop a preoperative prognostic model to predict surgical success, defined as a complete (R0) resection without 90-day mortality, in patients with resectable PHC on imaging. Study Design: Patients with PHC who underwent exploratory laparotomy in three tertiary referral centers were identified. Multivariable logistic regression was performed to identify preoperatively available prognostic factors. A prognostic model was developed using data from two European centers and validated in one American center. Results: In total, 671 patients with PHC underwent exploratory laparotomy. In the derivation cohort, surgical success was achieved in 102 of 331 patients (30.8%). No resection was performed in 176 patients (53.2%) because of metastatic or locally advanced disease. Of the 155 patients (46.8%) who underwent a resection, 38 (24.5%) had an R1-resection. Of the remaining 117 (35.3%), 15 (12.8%) had 90-day mortality. Independent poor prognostic factors for surgical success were identified, and a preoperative prognostic model was developed with a concordance index of 0.71. External validation showed good concordance (0.70). Conclusion: Surgical success was achieved in only 30% of patients with PHC undergoing exploratory laparotomy and could be predicted by age, cholangitis, hepatic artery involvement, lymph node metastases, and Blumgart stage.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85052640007&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30132904
U2 - https://doi.org/10.1002/jso.25174
DO - https://doi.org/10.1002/jso.25174
M3 - Article
C2 - 30132904
SN - 0022-4790
VL - 118
SP - 469
EP - 476
JO - Journal of surgical oncology
JF - Journal of surgical oncology
IS - 3
ER -