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A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma.

Publication ,  Journal Article
Gaspersz, MP; Buettner, S; Roos, E; van Vugt, JLA; Coelen, RJS; Vugts, J; Wiggers, JK; Allen, PJ; Besselink, MG; Busch, ORC; Belt, EJ ...
Published in: J Surg Oncol
September 2018

BACKGROUND: Patients with resectable perihilar cholangiocarcinoma (PHC) on imaging have a substantial risk of metastatic or locally advanced disease, incomplete (R1) resection, and 90-day mortality. Our aim was to develop a preoperative prognostic model to predict surgical success, defined as a complete (R0) resection without 90-day mortality, in patients with resectable PHC on imaging. STUDY DESIGN: Patients with PHC who underwent exploratory laparotomy in three tertiary referral centers were identified. Multivariable logistic regression was performed to identify preoperatively available prognostic factors. A prognostic model was developed using data from two European centers and validated in one American center. RESULTS: In total, 671 patients with PHC underwent exploratory laparotomy. In the derivation cohort, surgical success was achieved in 102 of 331 patients (30.8%). No resection was performed in 176 patients (53.2%) because of metastatic or locally advanced disease. Of the 155 patients (46.8%) who underwent a resection, 38 (24.5%) had an R1-resection. Of the remaining 117 (35.3%), 15 (12.8%) had 90-day mortality. Independent poor prognostic factors for surgical success were identified, and a preoperative prognostic model was developed with a concordance index of 0.71. External validation showed good concordance (0.70). CONCLUSION: Surgical success was achieved in only 30% of patients with PHC undergoing exploratory laparotomy and could be predicted by age, cholangitis, hepatic artery involvement, lymph node metastases, and Blumgart stage.

Duke Scholars

Published In

J Surg Oncol

DOI

EISSN

1096-9098

Publication Date

September 2018

Volume

118

Issue

3

Start / End Page

469 / 476

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Models, Statistical
  • Middle Aged
  • Male
  • Klatskin Tumor
  • Humans
 

Citation

APA
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ICMJE
MLA
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Gaspersz, M. P., Buettner, S., Roos, E., van Vugt, J. L. A., Coelen, R. J. S., Vugts, J., … Groot Koerkamp, B. (2018). A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma. J Surg Oncol, 118(3), 469–476. https://doi.org/10.1002/jso.25174
Gaspersz, Marcia P., Stefan Buettner, Eva Roos, Jeroen L. A. van Vugt, Robert J. S. Coelen, Jaynee Vugts, Jimme K. Wiggers, et al. “A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma.J Surg Oncol 118, no. 3 (September 2018): 469–76. https://doi.org/10.1002/jso.25174.
Gaspersz MP, Buettner S, Roos E, van Vugt JLA, Coelen RJS, Vugts J, et al. A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma. J Surg Oncol. 2018 Sep;118(3):469–76.
Gaspersz, Marcia P., et al. “A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma.J Surg Oncol, vol. 118, no. 3, Sept. 2018, pp. 469–76. Pubmed, doi:10.1002/jso.25174.
Gaspersz MP, Buettner S, Roos E, van Vugt JLA, Coelen RJS, Vugts J, Wiggers JK, Allen PJ, Besselink MG, Busch ORC, Belt EJ, D’Angelica MI, DeMatteo RP, de Jonge J, Kingham TP, Polak WG, Willemssen FEJA, van Gulik TM, Jarnagin WR, Ijzermans JNM, Groot Koerkamp B. A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma. J Surg Oncol. 2018 Sep;118(3):469–476.
Journal cover image

Published In

J Surg Oncol

DOI

EISSN

1096-9098

Publication Date

September 2018

Volume

118

Issue

3

Start / End Page

469 / 476

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Models, Statistical
  • Middle Aged
  • Male
  • Klatskin Tumor
  • Humans