Management of hilum infiltrating tumors of the liver: The impact of experience and standardization on outcome

Francesca Ratti, Federica Cipriani, Guido Fiorentini, Camila Hidalgo Salinas, Marco Catena, Michele Paganelli, Luca Aldrighetti

Research output: Contribution to journalArticle

Abstract

Background: The primary endpoint of this study was to evaluate the outcome of surgery for perihilar cholangiocarcinoma in a high-volume tertiary referral center. Methods: The study population consisted of 196 consecutive patients with histologically confirmed perihilar cholangiocarcinoma-PHC-who were candidates to surgical treatment. Factors affecting postoperative morbidity were evaluated in the whole series (primary endpoint) and after stratification of patients according to the following criteria: (a) perioperative management protocol implementation; (b) monocentric management (secondary endpoint). Results: The postoperative morbidity rate was 51.5% and mortality 4.1%. The most frequent cause of death was postoperative liver failure. At multivariate analysis, factors affecting the risk of morbidity were: side of hepatectomy, liver volume, intraoperative blood loss, preoperative optimization and single-center management. Patients treated according to preoperative optimization protocol, as well as patients with monocentric management experienced a significant reduction of postoperative morbidity. Preoperative optimization and single-center management significantly affected even long term outcome of patients. Conclusion: Despite continuous improvement in the surgical field, hilum-infiltrating tumors still remain associated with therapeutic and management challenges: a correct preoperative management in a tertiary referral center provides a benefit in terms of morbidity and mortality, thus improving long term results.

Original languageEnglish
Pages (from-to)135-141
Number of pages7
JournalDigestive and Liver Disease
Volume51
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Hilar cholangiocarcinoma
  • Liver surgery
  • Monocentric management
  • Preoperative optimization

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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