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Safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients

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Abstract

Purpose

To evaluate the safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients and to identify possible predictors of surgical mortality.

Methods

We retrospectively analyzed the data of 102 consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma in our institution between 2004 and 2021. The patients were included and divided into two groups: older patients ≥ 75 years and non-older patients < 75 years. Patient characteristics, preoperative nutritional and operative risk scores, intraoperative details, postoperative outcomes, and long-term prognosis were compared between the groups. Univariate and multivariate analyses were used to identify the predictors of 90-day mortality after major hepatectomy with extrahepatic bile duct resection.

Results

Significant differences were identified for some preoperative surgical risk scores, but not for nutritional scores. Older patients had a higher morbidity rate of respiratory complications (p = 0.016), but there were no significant differences in overall (p = 0.735) or disease-specific survival (p = 0.858). A high Dasari’s score was identified as an independent predictive factor of 90-day mortality.

Conclusions

Major hepatectomy with extrahepatic bile duct resection can be performed for optimally selected older and younger patients with perihilar cholangiocarcinoma, resulting in a good prognosis. However, indications for extended surgery should be recognized. Dasari’s preoperative risk score may be a good predictor of 90-day mortality.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing and Dr. Toru Ogura (Clinical Research Support Center, Mie University Hospital) for statistical support.

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Authors and Affiliations

  1. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan

    Koki Maeda, Naohisa Kuriyama, Takahiro Ito, Kazuyuki Gyoten, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada & Shugo Mizuno

  2. Regional Medical Support Center, Mie University Hospital, Tsu city, Mie, Japan

    Koki Maeda

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Contributions

Study conception and design: KM and NK. Acquisition of data: TI, KG, AH, TF, YI, YM, AT, and MK. Analysis and interpretation of data: KM. Drafting of manuscript: KM and NK. Critical revision of manuscript: SM. All authors read and approved the final manuscript.

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Maeda, K., Kuriyama, N., Ito, T. et al. Safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients. Langenbecks Arch Surg 407, 2861–2872 (2022). https://doi.org/10.1007/s00423-022-02654-x

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