The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma.

Autor: van Keulen AM; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. a.m.vankeulen@erasmusmc.nl., Olthof PB; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Buettner S; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Bednarsch J; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany., Verheij J; Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Erdmann JI; Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Nooijen LE; Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Porte RJ; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Minnee RC; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Murad SD; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Neumann UP; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands., Heij L; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.; Department of Pathology, Erasmus MC, Rotterdam, The Netherlands., Groot Koerkamp B; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Doukas M; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands. m.doukas@erasmusmc.nl.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jan; Vol. 31 (1), pp. 133-141. Date of Electronic Publication: 2023 Oct 29.
DOI: 10.1245/s10434-023-14419-x
Abstrakt: Background: Surgical resection for perihilar cholangiocarcinoma (pCCA) is associated with high operative risks. Impaired liver regeneration in patients with pre-existing liver disease may contribute to posthepatectomy liver failure (PHLF) and postoperative mortality. This study aimed to determine the incidence of hepatic steatosis and fibrosis and their association with PHLF and 90-day postoperative mortality in pCCA patients.
Methods: Patients who underwent a major liver resection for pCCA were included in the study between 2000 and 2021 from three tertiary referral hospitals. Histopathologic assessment of hepatic steatosis and fibrosis was performed. The primary outcomes were PHLF and 90-day mortality.
Results: Of the 401 included patients, steatosis was absent in 334 patients (83.3%), mild in 58 patients (14.5%) and moderate to severe in 9 patients (2.2%). There was no fibrosis in 92 patients (23.1%), periportal fibrosis in 150 patients (37.6%), septal fibrosis in 123 patients (30.8%), and biliary cirrhosis in 34 patients (8.5%). Steatosis (≥ 5%) was not associated with PHLF (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.69-2.68) or 90-day mortality (OR 1.22; 95% CI 0.62-2.39). Neither was fibrosis (i.e., periportal, septal, or biliary cirrhosis) associated with PHLF (OR 0.76; 95% CI 0.41-1.41) or 90-day mortality (OR 0.60; 95% CI 0.33-1.06). The independent risk factors for PHLF were preoperative cholangitis (OR 2.38; 95% CI 1. 36-4.17) and future liver remnant smaller than 40% (OR 2.40; 95% CI 1.31-4.38). The independent risk factors for 90-day mortality were age of 65 years or older (OR 2.40; 95% CI 1.36-4.23) and preoperative cholangitis (OR 2.25; 95% CI 1.30-3.87).
Conclusion: In this study, no association could be demonstrated between hepatic steatosis or fibrosis and postoperative outcomes after resection of pCCA.
(© 2023. The Author(s).)
Databáze: MEDLINE
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