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A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma
Author(s) -
Gaspersz Marcia P.,
Buettner Stefan,
Roos Eva,
Vugt Jeroen L.A.,
Coelen Robert J.S.,
Vugts Jaynee,
Wiggers Jimme K.,
Allen Peter J.,
Besselink Marc G.,
Busch Olivier R.C.,
Belt Eric J.,
D’Angelica Michael I.,
DeMatteo Ronald P.,
Jonge Jeroen,
Kingham T. Peter,
Polak Wojciech G.,
Willemssen François E.J.A.,
Gulik Thomas M.,
Jarnagin William R.,
Ijzermans Jan N.M.,
Groot Koerkamp Bas
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25174
Subject(s) - medicine , exploratory laparotomy , laparotomy , concordance , stage (stratigraphy) , surgery , lymph node , radiology , cohort , paleontology , biology
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.