Predictors and Prognostic Significance of Postoperative Complications for Patients with Intrahepatic Cholangiocarcinoma

Yutaka Endo, Zorays Moazzam, Selamawit Woldesenbet, Henrique Araujo Lima, Laura Alaimo, Muhammad Musaab Munir, Chanza F. Shaikh, Alfredo Guglielmi, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Minoru Kitago, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François CauchyBas Groot Koerkamp, Itaru Endo, Timothy M. Pawlik

研究成果: Article査読

2 被引用数 (Scopus)

抄録

Background: The prognostic impact of major postoperative complications (POCs) for intrahepatic cholangiocarcinoma (ICC) remains ill-defined. We sought to analyze the relationship between POCs and outcomes relative to lymph node metastases (LNM) and tumor burden score (TBS). Methods: Patients who underwent resection of ICC between 1990–2020 were included from an international database. POCs were defined according to Clavien-Dindo classification ≥ 3. The prognostic impact of POCs was estimated relative to TBS categories (i.e., high and low) and lymph node status (i.e., N0 or N1). Results: Among 553 patients who underwent curative-intent resection for ICC, 128 (23.1%) individuals experienced POCs. Low TBS/N0 patients who experienced POCs presented with a higher risk of recurrence and death (3-year cumulative recurrence rate; POCs: 74.8% vs. no POCs: 43.5%, p = 0.006; 5-year overall survival [OS], POCs 37.8% vs. no POCs 65.8%, p = 0.003), while POCs were not associated with worse outcomes among high TBS and/or N1 patients. The Cox regression analysis confirmed that POCs were significant predictors of poor outcomes in low TBS/N0 patients (OS, hazard ratio [HR] 2.91, 95%CI 1.45–5.82, p = 0.003; recurrence free survival [RFS], HR 2.42, 95%CI 1.28–4.56, p = 0.007). Among low TBS/N0 patients, POCs were associated with early recurrence (within 2 years) (Odds ratio [OR] 2.79 95%CI 1.13–6.93, p = 0.03) and extrahepatic recurrence (OR 3.13, 95%CI 1.14–8.54, p = 0.03), in contrast to patients with high TBS and/or nodal disease. Conclusions: POCs were independent, negative prognostic determinants for both OS and RFS among low TBS/N0 patients. Perioperative strategies that minimize the risk of POCs are critical to improving prognosis, especially among patients harboring favorable clinicopathologic features.

本文言語English
ページ(範囲)1792-1800
ページ数9
ジャーナルWorld Journal of Surgery
47
7
DOI
出版ステータスPublished - 2023 7月

ASJC Scopus subject areas

  • 外科

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