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Insufficient future liver remnant and preoperative cholangitis predict perioperative outcome in perihilar cholangiocarcinoma.

未来肝脏残余量不足和术前胆管炎可预测肝门周围胆管癌的围手术期结局。

  • 影响因子:2.92
  • DOI:10.1016/j.hpb.2020.04.017
  • 作者列表:"Bednarsch J","Czigany Z","Lurje I","Amygdalos I","Strnad P","Halm P","Wiltberger G","Ulmer TF","Schulze-Hagen M","Bruners P","Neumann UP","Lurje G
  • 发表时间:2020-06-13
Abstract

BACKGROUND:Major liver resection has evolved as the mainstay of treatment for patients with perihilar cholangiocarcinoma (pCCA). Here we assessed the suitability of preoperative future liver remnant (FLR) measurement to predict perioperative complications, since surgical morbidity and mortality are high compared to other malignancies. METHODS:Between 2011 and 2016, 91 patients with pCCA underwent surgery in curative intent at our institution. The associations of surgical complications with FLR and clinico-pathological characteristics were assessed using logistic regression analyses. Different methods of FLR assessment, the calculated-FLR (cFLR; ratio of FLR to total liver volume), standardized FLR (sFLR; ratio of FLR to liver volume estimated by body surface area) and FLR to bodyweight ratio (FLR/BW) were tested for validity. RESULTS:Multivariable analysis identified preoperative cholangitis (Exp(B) = 0.236; p = 0.030) as the single significant predictor of postoperative mortality and cFLR (Exp(B) = 0.009, p = 0.004) as the single significant predictor of major postoperative morbidity (Clavien-Dindo ≥ 3b). Based on these findings we designed a futility criterion (cFLR<40% OR preoperative cholangitis) predicting in-house mortality. CONCLUSIONS:In patients with pCCA, the preoperative FLR<40% as well as preoperative cholangitis are two risk factors to independently predict perioperative morbidity and mortality. The cFLR should be the preferred method of liver volumetry.

摘要

背景: 大肝切除已经发展成为肝门部周围胆管癌 (pCCA) 患者的主要治疗手段。在这里,我们评估了术前未来肝脏残余 (FLR) 测量预测围手术期并发症的适宜性,因为手术发病率和死亡率与其他恶性肿瘤相比较高。 方法: 在 2011-2016 之间,91 例 pCCA 患者在我们机构接受了治疗意向手术。使用 logistic 回归分析评估手术并发症与 FLR 和临床病理特征的相关性。FLR 评估的不同方法,计算的-FLR (cFLR; FLR 与总肝脏体积的比值),标准化 FLR (sFLR; FLR 与体表面积估计的肝脏体积的比值) 和 FLR 与体重比 (FLR/BW) 进行了有效性测试。 结果: 多变量分析确定术前胆管炎 (Exp(B) = 0.236; p = 0.030) 是术后死亡率的单一显著预测因子,cFLR (Exp(B) = 0.009, p = 0.004) 作为术后主要发病率的单一显著预测因子 (Clavien-Dindo ≥ 3b)。基于这些发现,我们设计了一个无效标准 (cFLR<40% 或术前胆管炎) 预测内部死亡率。 结论: 在 pCCA 患者中,术前 FLR<40% 和术前胆管炎是独立预测围手术期发病率和死亡率的两个危险因素。CFLR 应该是肝脏体积测定的首选方法。

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