Prognostic Factors for Bile Leak and Long-Term Survival in 23 Patients with Klatskin Type III Tumors

Antoine R El Asmar,Ziad El Rassi,Bernard Akl,Christina Abou-Malhab,Elie Ghabi,Toufic Saber

doi:10.31487/j.cor.2020.11.03

Abstract

Objective: Surgical resection of hilar cholangiocarcinoma carries significant morbidity and mortality, particularly if postoperative bile leak occurs. Prognostic factors and scoring tools have been described for overall morbidity and mortality but none are specific for postoperative bile leak. In this study, we investigate the prognostic utility of various factors in predicting overall morbidity, mortality and risk of biliary leak in Bismuth Type III tumors with the hopes of developing a scoring tool in future research. Materials and Methods: A retrospective sample of 23 patients with Bismuth Type III tumors exclusively who underwent surgery between 2010 and 2017 were selected for this study. Demographic, surgical, pathologic and biochemical data were collected from the patients’ medical records. Results: 11 patients underwent a right hepatectomy for type IIIa tumors and 10 patients underwent a left hepatectomy for type IIIb tumors. 2 patients were lost to follow up and were excluded. R0 resection was achieved in 20 patients. Overall survival at 1, 3 and 5 years was 78.3%, 61.9% and 38.1%, respectively. A BMI >24kg/m2 was associated with a worse prognosis, increased overall morbidity and decreased survival at 1, 3 and 5 years (p<0.05). A preoperative creatinine >0.74 was associated with decreased 5-year survival (p<0.05). Conclusion: A BMI >24kg/m2 and a preoperative creatinine >0.74 are associated with a poor prognosis in Bismuth Type III Klatskin tumors. Furthermore, Age, sex, preoperative hemoglobin, tumor size, use of CUSA and type IIIb tumors demonstrate a borderline significant association with the occurrence of postoperative bile leak.

Highlights

Hilar cholangiocarcinoma, or the Klatskin tumor named eponymously after Gerard Klatskin, arises from the extrahepatic biliary epithelium and accounts for 50-60% of cholangiocarcinoma cases, the second most common primary liver tumor after hepatocellular carcinoma [1]
We investigate the prognostic factors associated with overall postoperative morbidity and mortality of surgical resection of Bismuth-Corlette type III (BCT-III) tumors and attempt to identify those predictive of postoperative bile leak (PBL) with the hopes of creating a prognostic scoring tool to further improve patient outcomes and overall survival
23 patients were selected for this study. 2 patients were lost to follow-up and were excluded from subsequent statistical analysis

Summary

Introduction

Hilar cholangiocarcinoma (hCCA), or the Klatskin tumor named eponymously after Gerard Klatskin, arises from the extrahepatic biliary epithelium and accounts for 50-60% of cholangiocarcinoma cases, the second most common primary liver tumor after hepatocellular carcinoma [1]. To achieve R0 resections, major hepatectomies are necessary due to the aggressive biology of the hCCA. These tumors exhibit a high degree of lymphovascular invasion and lymphangitis carcinomatosa up to 2cm away from the tumor and towards both the liver and hepatoduodenal ligament [6, 7]. For the case of type III tumors, a hepatectomy, right for type IIIa and left for type IIIb, is necessary [4]

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Conclusion