TY - JOUR
T1 - Management of hilum infiltrating tumors of the liver
T2 - The impact of experience and standardization on outcome
AU - Ratti, Francesca
AU - Cipriani, Federica
AU - Fiorentini, Guido
AU - Hidalgo Salinas, Camila
AU - Catena, Marco
AU - Paganelli, Michele
AU - Aldrighetti, Luca
PY - 2019/1
Y1 - 2019/1
N2 - 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.
AB - 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.
KW - Hilar cholangiocarcinoma
KW - Liver surgery
KW - Monocentric management
KW - Preoperative optimization
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UR - http://www.scopus.com/inward/citedby.url?scp=85051374825&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2018.07.006
DO - 10.1016/j.dld.2018.07.006
M3 - Article
C2 - 30115572
AN - SCOPUS:85051374825
VL - 51
SP - 135
EP - 141
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 1
ER -