Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Christian Benzing,Annika Wolfsberger,Johann Pratschke,Uli Fehrenbach,Nora Nevermann,Alexa Mieg,Moritz Schmelzle,Cecilia Filiz Atik,Felix Krenzien,Wenzel Schöning,Lena Marie Haiden

doi:10.1007/s00423-022-02467-y

Christian Benzing, Annika Wolfsberger + Show 9 more

Open Access

https://doi.org/10.1007/s00423-022-02467-y

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Abstract

PurposeThe concept of “textbook outcome” (TO) as composite quality measure depicting the ideal surgical has not yet been defined for patients undergoing major hepatectomy (MH) for perihilar cholangiocarcinoma (PHC). This study sought to propose a uniform definition through a systematic literature review as well as to identify patient- or procedure-related factors influencing TO.MethodsIn this retrospective study, we analyzed all patients undergoing MH for PHC at our department between January 2005 and August 2019. After conducting a systematic literature search, we defined TO as the absence of 90-day mortality and major complications, no hospital readmission within 90 days after discharge, and no prolonged hospital stay (<75. percentile). A binary logistic regression analysis was performed to identify factors influencing TO.ResultsOf 283 patients, TO was achieved in 67 (24%) patients. Multivariate analysis revealed that preoperative biliary drainage was associated with a decreased (OR= 0.405, 95% CI: 0.194–0.845, p=0.016) and left-sided-resection (OR= 1.899, 95% CI: 1.048–3.440, p=0.035) with increased odds for TO. Overall survival (OS) and DFS (disease-free survival) did not differ significantly between the outcome groups (OS: p=0.280, DFS: p=0.735). However, there was a trend towards better overall survival, especially in the late course with TO.ConclusionOur analysis proposed a uniform definition of TO after MH for PHC. We identified left hepatectomy as an independent factor positively influencing TO. In patients where both right- and left-sided resections are feasible, this underlines the importance of a careful selection of patients who are scheduled for right hepatectomy.

Highlights

Perihilar cholangiocarcinoma (PHC) is a rare malignant tumor arising from the bile duct that is characterized by a poor prognosis [1]
We introduced the composite quality measure textbook outcome” (TO) into PHC
This is of great importance in order to allow a comparison between studies or centers

Summary

Introduction

Perihilar cholangiocarcinoma (PHC) is a rare malignant tumor arising from the bile duct that is characterized by a poor prognosis [1]. Major hepatectomy (MH) is the only established, potentially curative treatment for patients with PHC. Radical surgical approaches such as hilar en bloc resection described by Neuhaus and colleagues were able to increase overall survival rates in the last years [2, 3]. High postoperative morbidity and mortality still remain unsatisfactory, despite advances in preoperative workup such as portal vein embolization (PVE) and improvements in perioperative management [4–6]. Diagnosis at an advanced stage, which is often accompanied by bile duct obstruction, cholestasis, cholangitis, and poor liver function, and radical surgical approaches are associated with morbidity. Common complications are bile leakage, septic, or vascular complications; posthepatectomy liver failure (PHLF) being associated with a high associated mortality is feared the most [7, 12]

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