Surgical Management of Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Impact of Lymphadenectomy on Peri-Operative Outcomes
| Autor: | Gaya Spolverato, Hugo Marques, Fabio Bagante, Carlo Pulitano, Guillaume Martel, Andrea Ruzzenente, George A. Poultsides, Luca Aldrighetti, Timothy M. Pawlik, Alfredo Guglielmi, Matthew J. Weiss, B. Groot Koerkamp, Sorin Alexandrescu, Feng Shen, Endo Itaru, Shishir K. Maithel, Olivier Soubrane, Todd W. Bauer |
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| Přispěvatelé: | Surgery, Bagante, F, Spolverato, G, Weiss, M, Alexandrescu, S, Marques, Hp, Aldrighetti, L, Maithel, Sk, Pulitano, C, Bauer, Tw, Shen, F, Poultsides, Ga, Soubrane, O, Martel, G, Koerkamp, Bg, Guglielmi, A, Itaru, E, Ruzzenente, A, Pawlik, Tm |
| Rok vydání: | 2018 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Cirrhosis Intrahepatic Cholangiocarcinoma Lymphadenectomy medicine.medical_treatment Lymph Node Excision/adverse effects Bile Duct Neoplasms/surgery Gastroenterology Cholangiocarcinoma Hepatectomy/adverse effects 03 medical and health sciences 0302 clinical medicine Liver Cirrhosis/complications Internal medicine Intrahepatic Cholangiocarcinoma Cirrhosis Lymphadenectomy Medicine Hepatectomy Humans Aged Retrospective Studies Cholangiocarcinoma/surgery business.industry Retrospective cohort study Perioperative Middle Aged medicine.disease HCC CIR Bile Duct Neoplasms Cardiothoracic surgery 030220 oncology & carcinogenesis Lymph Node Excision 030211 gastroenterology & hepatology Surgery Female business Abdominal surgery |
| Zdroj: | World Journal of Surgery, 42(8), 2551-2560. Springer New York Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP |
| ISSN: | 1432-2323 0364-2313 |
| Popis: | BACKGROUND: The consequences of lymphadenectomy (LND) on cirrhotic patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC) have not been investigated. We sought to analyze the impact of LND on morbidity among patients undergoing resection for ICC. METHODS: A total of 1005 patients who underwent hepatectomy for ICC at one of the 14 participating institutions between 1990 and 2015 were identified. A propensity score match analysis was performed to reduce confounding biases between cirrhosis and non-cirrhosis groups. RESULTS: Cirrhosis was diagnosed in 118 (11.7%) patients. Among non-cirrhotic patients, 63% underwent major liver resection versus only 20% among patients with cirrhosis (p < 0.001). LND was also less common among cirrhotic versus non-cirrhotic patients (19 vs. 50%, p < 0.001). The incidence of complications was 41 and 30% among patients who did not and did have cirrhosis, respectively (p = 0.022). The propensity-matched cohort included 150 patients. The incidence of complications was 71% among patients who underwent lymphadenectomy versus 23% among patients who did not undergo lymphadenectomy (OR 8.39) (p < 0.001). In the propensity-matched analysis, the median HLN was comparable among patients independent of cirrhosis status (median HLN: non-cirrhosis, 2.5 vs. cirrhosis, 2) (p = 0.95). While lymphadenectomy was associated with a higher risk of infections (non-cirrhosis, 0% vs. cirrhosis, 21%, p < 0.001) among patients with cirrhosis, infections were not associated with lymphadenectomy among non-cirrhotic patients (p = 0.19). CONCLUSION: Lymphadenectomy was associated with an increased risk of complications among patients with cirrhosis undergoing surgery for ICC. The benefit of lymphadenectomy in cirrhotic patients should be considered in light of the higher risk of postoperative complications compared with non-cirrhotic patients. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
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