Anatomical hepatectomy for achieving textbook outcome for perihilar cholangiocarcinoma treated with curative-intent resection: A multicenter study

Abstract

The textbook outcome (TO) is a comprehensive measure that is superior to individual measures for analysis of surgical quality of care. Anatomical hepatectomy (AH) is beneficial in terms of short-term outcomes in patients undergoing resection. This study was performed to investigate the association between AH and achieving the TO for patients with perihilar cholangiocarcinoma (pCCA) treated with curative-intent resection. This study involved patients who underwent curative-intent resection for newly diagnosed pCCA from January 2013 to January 2018 at three hospitals in China. All patients were divided into two groups according to the type of hepatectomy: the AH group and non-AH group. The incidence and distribution of achieving the TO were compared between the two groups. Univariable and multivariable logistic regression analyses were used to identify independently predictive factors associated with achieving the TO in patients with pCCA. In total, 333 patients were enrolled [AH group, 225 (67.6%); non-AH group, 108 (32.4%)]. The incidence of achieving the TO in all patients was 24.3%, and the incidence was significantly higher in the AH than non-AH group (30.7% vs. 11.1%, respectively). Multivariable analysis revealed that AH, total bilirubin concentration of <34 μmol/L, maximum tumor size of < 3 cm, no macrovascular invasion, and no lymph node metastasis were independently associated with a higher incidence of achieving the TO. The TO was achieved in approximately one-fourth of patients with pCCA who underwent curative-intent resection. The use of AH was more conducive to achieving the TO in patients with pCCA. • The textbook outcome is a patient-centered composite measure and represents the optimal short-term outcome. • Anatomic hepatectomy may be beneficial to short-term outcomes. • A higher probability of achieving textbook outcomes was observed after anatomic hepatectomy for perihilar cholangiocarcinoma.