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. 2022 Jun;407(4):1561-1573.
doi: 10.1007/s00423-022-02467-y. Epub 2022 Mar 4.

Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma - definitions and influencing factors

Christian Benzing  1 , Lena Marie Haiden  1 , Felix Krenzien  1 , Alexa Mieg  1 , Annika Wolfsberger  1 , Cecilia Filiz Atik  1 , Nora Nevermann  1 , Uli Fehrenbach  2 , Wenzel Schöning  1 , Moritz Schmelzle  3 , Johann Pratschke  1
Affiliations

Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma - definitions and influencing factors

Christian Benzing et al. Langenbecks Arch Surg. 2022 Jun.

Abstract

Purpose: The concept of "textbook outcome" (TO) as composite quality measure depicting the ideal surgical has not yet been defined for patients undergoing major hepatectomy (MH) for perihilar cholangiocarcinoma (PHC). This study sought to propose a uniform definition through a systematic literature review as well as to identify patient- or procedure-related factors influencing TO.

Methods: In this retrospective study, we analyzed all patients undergoing MH for PHC at our department between January 2005 and August 2019. After conducting a systematic literature search, we defined TO as the absence of 90-day mortality and major complications, no hospital readmission within 90 days after discharge, and no prolonged hospital stay (<75. percentile). A binary logistic regression analysis was performed to identify factors influencing TO.

Results: Of 283 patients, TO was achieved in 67 (24%) patients. Multivariate analysis revealed that preoperative biliary drainage was associated with a decreased (OR= 0.405, 95% CI: 0.194-0.845, p=0.016) and left-sided-resection (OR= 1.899, 95% CI: 1.048-3.440, p=0.035) with increased odds for TO. Overall survival (OS) and DFS (disease-free survival) did not differ significantly between the outcome groups (OS: p=0.280, DFS: p=0.735). However, there was a trend towards better overall survival, especially in the late course with TO.

Conclusion: Our analysis proposed a uniform definition of TO after MH for PHC. We identified left hepatectomy as an independent factor positively influencing TO. In patients where both right- and left-sided resections are feasible, this underlines the importance of a careful selection of patients who are scheduled for right hepatectomy.

Keywords: Major hepatectomy; Perihilar cholangiocarcinoma; Textbook outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of search algorithm
Fig. 2
Fig. 2
Overall survival and disease-free survival according to outcome group. Kaplan-Meier curves of (A) overall survival of all resected patients with perihilar cholangiocarcinoma excluding 90-day mortality according to outcome group; (B) overall survival of all resected patients surviving >30 months according to outcome group; (C) disease-free survival of all resected patients with perihilar cholangiocarcinoma excluding 90-day mortality according to outcome group; and (D) disease-free survival of all resected patients with perihilar cholangiocarcinoma surviving >30 months according to outcome group
See this image and copyright information in PMC

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