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Multicenter Study
. 2021 Nov 1;274(5):780-788.
doi: 10.1097/SLA.0000000000005103.

Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers

Matteo Mueller  1 , Eva Breuer  1 , Takashi Mizuno  2 , Fabian Bartsch  3 , Francesca Ratti  4 , Christian Benzing  5 , Noémie Ammar-Khodja  6 , Teiichi Sugiura  7 , Tsukasa Takayashiki  8 , Amelia Hessheimer  9 , Hyung Sun Kim  10 , Andrea Ruzzenente  11 , Keun Soo Ahn  12 , Tiffany Wong  13 , Jan Bednarsch  14 , Mizelle D'Silva  15 , Bas Groot Koerkamp  16 , Heithem Jeddou  17 , Victor López-López  18 , Charles de Ponthaud  19 , Jennifer A Yonkus  20 , Warsan Ismail  21 , Lynn E Nooijen  22 , Camila Hidalgo-Salinas  23 , Elissaios Kontis  24 , Kim C Wagner  25 , Ganesh Gunasekaran  26 , Ryota Higuchi  27 , Ana Gleisner  28 , Chaya Shwaartz  29 , Gonzalo Sapisochin  29 , Richard D Schulick  28 , Masakazu Yamamoto  27 , Takehiro Noji  30 , Satoshi Hirano  30 , Myron Schwartz  26 , Karl J Oldhafer  25 , Andreas Prachalias  24 , Giuseppe K Fusai  23 , Joris I Erdmann  22 , Pål-Dag Line  31 , Rory L Smoot  20 , Olivier Soubrane  19 , Ricardo Robles-Campos  18 , Karim Boudjema  17 , Wojciech G Polak  16 , Ho-Seong Han  15 , Ulf P Neumann  14 , Chung-Mau Lo  13 , Koo Jeong Kang  12 , Alfredo Guglielmi  11 , Joon Seong Park  10 , Constantino Fondevila  9 , Masayuki Ohtsuka  8 , Katsuhiko Uesaka  7 , René Adam  6 , Johann Pratschke  5 , Luca Aldrighetti  4 , Michelle L De Oliveira  1 , Gregory J Gores  32 , Hauke Lang  3 , Masato Nagino  2 , Pierre-Alain Clavien  1
Affiliations
Multicenter Study

Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers

Matteo Mueller et al. Ann Surg. .

Abstract

Objective: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons.

Background: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking.

Methods: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers.

Results: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes.

Conclusion: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

References

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