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  • van Keulen, AM (author)

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?

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • 2023-03-15
  • Oxford University Press (OUP),2023

Numbers

  • LIBRIS-ID:oai:prod.swepub.kib.ki.se:152099073
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:152099073URI
  • https://doi.org/10.1093/bjs/znad057DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

Added entries (persons, corporate bodies, meetings, titles ...)

  • Buettner, S (author)
  • Erdmann, JI (author)
  • Pratschke, J (author)
  • Ratti, F (author)
  • Jarnagin, WR (author)
  • Schnitzbauer, AA (author)
  • Lang, H (author)
  • Ruzzenente, A (author)
  • Nadalin, S (author)
  • Cescon, M (author)
  • Topal, B (author)
  • Olthof, PB (author)
  • Koerkamp, BG (author)

Related titles

  • In:The British journal of surgery: Oxford University Press (OUP)110:5, s. 599-6051365-21680007-1323

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