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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00003402naa a2200397 4500
001oai:prod.swepub.kib.ki.se:152099073
003SwePub
008240701s2023 | |||||||||||000 ||eng|
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1520990732 URI
0247 a https://doi.org/10.1093/bjs/znad0572 DOI
040 a (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a van Keulen, AM4 aut
2451 0a 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?
264 c 2023-03-15
264 1b Oxford University Press (OUP),c 2023
520 a 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.
7001 a Buettner, S4 aut
7001 a Erdmann, JI4 aut
7001 a Pratschke, J4 aut
7001 a Ratti, F4 aut
7001 a Jarnagin, WR4 aut
7001 a Schnitzbauer, AA4 aut
7001 a Lang, H4 aut
7001 a Ruzzenente, A4 aut
7001 a Nadalin, S4 aut
7001 a Cescon, M4 aut
7001 a Topal, B4 aut
7001 a Olthof, PB4 aut
7001 a Koerkamp, BG4 aut
7730 t The British journal of surgeryd : Oxford University Press (OUP)g 110:5, s. 599-605q 110:5<599-605x 1365-2168x 0007-1323
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:152099073
8564 8u https://doi.org/10.1093/bjs/znad057

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