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Multicenter Study
. 2025 Mar;32(3):1762-1768.
doi: 10.1245/s10434-024-16293-7. Epub 2024 Oct 15.

Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort

Pim B Olthof #  1   2   3 , Stefan A W Bouwense #  4 , Jan Bednarsch  4   5 , Maxime Dewulf  4 , Geert Kazemier  6 , Shishir Maithel  7 , William R Jarnagin  8 , Luca Aldrighetti  9 , Keith J Roberts  10 , Roberto I Troisi  11 , Massimo M Malago  12 , Hauke Lang  13 , Ruslan Alikhanov  14 , Andrea Ruzzenente  15 , Hassan Malik  16 , Ramón Charco  17 , Ernesto Sparrelid  18 , Johann Pratschke  19 , Matteo Cescon  20 , Silvio Nadalin  21 , Jeroen Hagendoorn  22 , Erik Schadde  23 , Frederik J H Hoogwater  24 , Andreas A Schnitzbauer  25 , Baki Topal  26 , Peter Lodge  27 , Steven W M Olde Damink  4 , Ulf P Neumann #  4   5 , Bas Groot Koerkamp #  28 ; Perihilar Cholangiocarcinoma Collaboration Group
Collaborators, Affiliations
Multicenter Study

Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort

Pim B Olthof et al. Ann Surg Oncol. 2025 Mar.

Abstract

Background: Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR.

Patients and method: Patients who underwent major liver resection for pCCA at 27 centers were included. FTR was defined as the presence of a Dindo grade III or higher complication followed by death within 90 days after surgery. Liver failure ISGLS grade B/C were scored. Multivariable logistic analysis was performed to identify predictors of FTR and reported using odds ratio and 95% confidence intervals.

Results: In the 2186 included patients, major morbidity rate was 49%, 90-day mortality rate 13%, and FTR occurred in 24% of patients with a grade III or higher complication. Across centers, major complication rate varied from 19 to 87%, 90-day mortality rate from 5 to 33%, and FTR ranged from 11 to 50% across hospitals. Age [1.04 (1.02-1.05) years], ASA 3 or 4 [1.40 (1.01-1.95)], jaundice at presentation [1.79 (1.16-2.76)], right-sided resection [1.45 (1.06-1.98)], and annual hospital volume < 6 [1.44 (1.07-1.94)] were positively associated with FTR. When liver failure is included, the odds ratio for FTR is 9.58 (6.76-13.68).

Conclusion: FTR occurred in 24% of patients after resection for pCCA. Liver failure was associated with a nine-fold increase of FTR and hospital volume below six was also associated with an increased risk of FTR.

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Conflict of interest statement

Disclosures: Ulf Neumann presented for Astra Zeneca, Roche AG, Merck AG, and Dr Falk GMBH, BMS. No other conflicts of interest are present. Data available upon reasonable request.

Figures

Fig. 1
Fig. 1
A The 90-day mortality rates in hospitals categorized in quartiles based on 90-day mortality rate. B Major complication, C FTR, and D liver failure rates based in the 90-day mortality quartiles
See this image and copyright information in PMC

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