Cholangiocarcinoma:Predicting survival and complications after surgery

In Part I, survival of patients with perihilar cholangiocarcinoma (pCCA) is discussed. Chapter 2 evaluates the nationwide survival outcomes of treatment (i.e., resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e., academic, teaching, or regular hospital) of pCCA in the Netherlands. In Chapter 3, a mixture cure model was used to predict what factors precluded 10-year survival after resection of pCCA. In Chapter 4, a comparison of patient characteristics and survival outcomes between patients with localized pCCA (i.e., non-metastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy and pCCA patients who underwent R1 resection. Chapter 5 is a retrospective analysis of the success, complication, and mortality rate of initial biliary drainage in palliative patients with pCCA.In Part II, postoperative morbidity and mortality after resection of pCCA is discussed. In Chapter 6, the aim was to preoperatively assess when the predicted survival benefit no longer outweighs the surgical risk. Two separate preoperative risk models were created to predict both 90-day mortality and long-term survival for the individual patient. In Chapter 7 the occurrence and impact of readmissions, reinterventions, and complications throughout the first year after surgery for pCCA were investigated. Chapter 8 introduces the concepts of primary and secondary liver failure after major liver resection for pCCA, with identification of risk factors for each type of liver failure. The incidence of hepatic steatosis and fibrosis and their association with postoperative liver failure and mortality were evaluated in Chapter 9.In Part III, surgical and oncological outcomes of intrahepatic cholangiocarcinoma (iCCA) is discussed. In Chapter 10 the postoperative morbidity and mortality rate after resection of iCCA is evaluated in a systematic review and meta-analysis. Chapter 11 evaluated the nationwide survival outcomes of treatment (i.e. resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e. academic, teaching, or regular hospital) of iCCA in the Netherlands.<br/

Nationwide treatment and outcomes of intrahepatic cholangiocarcinoma

Background: Most data on the treatment and outcomes of intrahepatic cholangiocarcinoma (iCCA) derives from expert centers. This study aimed to investigate the treatment and outcomes of all patients diagnosed with iCCA in a nationwide cohort. Methods: Data on all patients diagnosed with iCCA between 2010 and 2018 were obtained from the Netherlands Cancer Registry. Results: In total, 1747 patients diagnosed with iCCA were included. Resection was performed in 292 patients (17%), 548 patients (31%) underwent palliative systemic treatment, and 867 patients (50%) best supportive care (BSC). The OS median and 1-, and 3-year OS were after resection: 37.5 months (31.0–44.0), 79.2%, and 51.6%,; with systemic therapy, 10.0 months (9.2–10.8), 38.4%, and 5.1%, and with BSC 2.2 months (2.0–2.5), 10.4%, and 1.3% respectively. The resection rate for patients who first presented in academic centers was 33% (96/292) compared to 13% (195/1454) in non-academic centers (P &lt; 0.001). Discussion: Half of almost 1750 patients with iCCA over an 8 year period did not receive any treatment with a 1-year OS of 10.4%. Three-year survival was about 50% after resection, while long-term survival was rare after palliative treatment. The resection rate was higher in academic centers compared to non-academic centers

The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma

Background: Surgical resection for perihilar cholangiocarcinoma (pCCA) is associated with high operative risks. Impaired liver regeneration in patients with pre-existing liver disease may contribute to posthepatectomy liver failure (PHLF) and postoperative mortality. This study aimed to determine the incidence of hepatic steatosis and fibrosis and their association with PHLF and 90-day postoperative mortality in pCCA patients. Methods: Patients who underwent a major liver resection for pCCA were included in the study between 2000 and 2021 from three tertiary referral hospitals. Histopathologic assessment of hepatic steatosis and fibrosis was performed. The primary outcomes were PHLF and 90-day mortality. Results: Of the 401 included patients, steatosis was absent in 334 patients (83.3%), mild in 58 patients (14.5%) and moderate to severe in 9 patients (2.2%). There was no fibrosis in 92 patients (23.1%), periportal fibrosis in 150 patients (37.6%), septal fibrosis in 123 patients (30.8%), and biliary cirrhosis in 34 patients (8.5%). Steatosis (≥ 5%) was not associated with PHLF (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.69–2.68) or 90-day mortality (OR 1.22; 95% CI 0.62–2.39). Neither was fibrosis (i.e., periportal, septal, or biliary cirrhosis) associated with PHLF (OR 0.76; 95% CI 0.41–1.41) or 90-day mortality (OR 0.60; 95% CI 0.33–1.06). The independent risk factors for PHLF were preoperative cholangitis (OR 2.38; 95% CI 1. 36–4.17) and future liver remnant smaller than 40% (OR 2.40; 95% CI 1.31–4.38). The independent risk factors for 90-day mortality were age of 65 years or older (OR 2.40; 95% CI 1.36–4.23) and preoperative cholangitis (OR 2.25; 95% CI 1.30–3.87). Conclusion: In this study, no association could be demonstrated between hepatic steatosis or fibrosis and postoperative outcomes after resection of pCCA.</p

Cholangiocarcinoma:Predicting survival and complications after surgery

In Part I, survival of patients with perihilar cholangiocarcinoma (pCCA) is discussed. Chapter 2 evaluates the nationwide survival outcomes of treatment (i.e., resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e., academic, teaching, or regular hospital) of pCCA in the Netherlands. In Chapter 3, a mixture cure model was used to predict what factors precluded 10-year survival after resection of pCCA. In Chapter 4, a comparison of patient characteristics and survival outcomes between patients with localized pCCA (i.e., non-metastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy and pCCA patients who underwent R1 resection. Chapter 5 is a retrospective analysis of the success, complication, and mortality rate of initial biliary drainage in palliative patients with pCCA.In Part II, postoperative morbidity and mortality after resection of pCCA is discussed. In Chapter 6, the aim was to preoperatively assess when the predicted survival benefit no longer outweighs the surgical risk. Two separate preoperative risk models were created to predict both 90-day mortality and long-term survival for the individual patient. In Chapter 7 the occurrence and impact of readmissions, reinterventions, and complications throughout the first year after surgery for pCCA were investigated. Chapter 8 introduces the concepts of primary and secondary liver failure after major liver resection for pCCA, with identification of risk factors for each type of liver failure. The incidence of hepatic steatosis and fibrosis and their association with postoperative liver failure and mortality were evaluated in Chapter 9.In Part III, surgical and oncological outcomes of intrahepatic cholangiocarcinoma (iCCA) is discussed. In Chapter 10 the postoperative morbidity and mortality rate after resection of iCCA is evaluated in a systematic review and meta-analysis. Chapter 11 evaluated the nationwide survival outcomes of treatment (i.e. resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e. academic, teaching, or regular hospital) of iCCA in the Netherlands.<br/

Actual 10-year survival after resection of perihilar cholangiocarcinoma: What factors preclude a chance for cure?

Complete resection of perihilar cholangiocarcinoma (pCCA) is the only potentially curative treatment. Long-term survival data is rare and prognostic analyses are hindered by the rarity of the disease. This study aimed to determine the cure rate and to identify clinicopathological factors that may preclude cure. All consecutive resections for pathologically confirmed pCCA between 2000 and 2009 in 22 centers worldwide were included in a retrospective cohort study. Each center included its retrospective data series. A total of 460 patients were included with a median followup of 10 years for patients alive at last follow-up. Median overall survival (OS) was 29.9 months and 10-year OS was 12.8%. Twenty-nine (6%) patients reached 10-year OS. The observed cure rate was 5%. Factors that virtually precluded cure (i.e., below 1%) according to the mixture cure model included age above 70, Bismuth-Corlette type IV tumors, hepatic artery reconstruction, and positive resection margins. Cure was unlikely (i.e., below 3%) in patients with positive lymph nodes or poor tumor differentiation. These factors need to be considered in patient counseling and long-term follow-up after surgery

Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis

Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma. Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III). Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44). Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection

Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis

Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma.  Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III).  Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44).  Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection