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Multivariable predi...
Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk?
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van Keulen, AM (author)
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Buettner, S (author)
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Erdmann, JI (author)
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Pratschke, J (author)
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Ratti, F (author)
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Jarnagin, WR (author)
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Schnitzbauer, AA (author)
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Lang, H (author)
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Ruzzenente, A (author)
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Nadalin, S (author)
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Cescon, M (author)
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Topal, B (author)
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Olthof, PB (author)
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Koerkamp, BG (author)
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- 2023-03-15
- 2023
- English.
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In: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 110:5, s. 599-605
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https://doi.org/10.1...
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Abstract
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- BackgroundThe risk of death after surgery for perihilar cholangiocarcinoma is high; nearly one in every five patients dies within 90 days after surgery. When the oncological benefit is limited, a high-risk resection may not be justified. This retrospective cohort study aimed to create two preoperative prognostic models to predict 90-day mortality and overall survival (OS) after major liver resection for perihilar cholangiocarcinoma.MethodsSeparate models were built with factors known before surgery using multivariable regression analysis for 90-day mortality and OS. Patients were categorized in three groups: favourable profile for surgical resection (90-day mortality rate below 10 per cent and predicted OS more than 3 years), unfavourable profile (90-day mortality rate above 25 per cent and/or predicted OS below 1.5 years), and an intermediate group.ResultsA total of 1673 patients were included. Independent risk factors for both 90-day mortality and OS included ASA grade III–IV, large tumour diameter, and right-sided hepatectomy. Additional risk factors for 90-day mortality were advanced age and preoperative cholangitis; those for long-term OS were high BMI, preoperative jaundice, Bismuth IV, and hepatic artery involvement. In total, 294 patients (17.6 per cent) had a favourable risk profile for surgery (90-day mortality rate 5.8 per cent and median OS 42 months), 271 patients (16.2 per cent) an unfavourable risk profile (90-day mortality rate 26.8 per cent and median OS 16 months), and 1108 patients (66.2 per cent) an intermediate risk profile (90-day mortality rate 12.5 per cent and median OS 27 months).ConclusionPreoperative risk models for 90-day mortality and OS can help identify patients with resectable perihilar cholangiocarcinoma who are unlikely to benefit from surgical resection. Tailored shared decision-making is particularly essential for the large intermediate group.
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- By the author/editor
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van Keulen, AM
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Buettner, S
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Erdmann, JI
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Pratschke, J
-
Ratti, F
-
Jarnagin, WR
-
show more...
-
Schnitzbauer, AA
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Lang, H
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Ruzzenente, A
-
Nadalin, S
-
Cescon, M
-
Topal, B
-
Olthof, PB
-
Koerkamp, BG
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show less...
- Articles in the publication
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The British jour ...
- By the university
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Karolinska Institutet