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1. Prognostic utility of albumin-bilirubin grade for short- and long-term outcomes following hepatic resection for intrahepatic cholangiocarcinoma: A multi-institutional analysis of 706 patients

Author

Tsilimigras, DI, Hyer, JM, Moris, D, Sahara, K, Bagante, F, Guglielmi, A, Aldrighetti, L, Alexandrescu, S, Marques, HP, Shen, F, Groot Koerkamp, B, Endo, I, Pawlik, TM, Merath, K, Paredes, AZ, Weiss, M, Bauer, TW, Poultsides, GA, Maithel, SK, Martel, G, Pulitano, C, Soubrane, O, Surgery, Tsilimigras, Di, Hyer, Jm, Moris, D, Sahara, K, Bagante, F, Guglielmi, A, Aldrighetti, L, Alexandrescu, S, Marques, Hp, Shen, F, Koerkamp, Bg, Endo, I, Pawlik, Tm, Merath, K, Paredes, Az, Weiss, M, Bauer, Tw, Poultsides, Ga, Maithel, Sk, Martel, G, Pulitano, C, and Soubrane, O

Subjects
Male, medicine.medical_specialty, complications, overall survival, Gastroenterology, Cholangiocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, Hepatectomy, Survival rate, albumin, Serum Albumin, Aged, Retrospective Studies, Surrogate endpoint, business.industry, ICC, Hazard ratio, Retrospective cohort study, Bilirubin, General Medicine, Odds ratio, Perioperative, Middle Aged, bilirubin, HCC CIR, Confidence interval, Survival Rate, Treatment Outcome, Bile Ducts, Intrahepatic, Oncology, Bile Duct Neoplasms, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Surgery, Female, business, Biomarkers
Abstract

Background: The objective of the current study was to define the impact of albumin-bilirubin (ALBI) grade on short- as well as long-term outcomes among patients with intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified using an international multi-institutional database. Clinicopathologic factors including ALBI score were assessed using bivariate and multivariable analyses, as well as standard survival analyses. Results: Among 706 patients, 453 (64.2%) patients had ALBI grade 1, 231 (32.7%) ALBI grade 2, and 22 (3.1%) had ALBI grade 3. After adjusting for all competing factors, patients with ALBI grade 2/3 had higher odds of a prolonged length-of-stay (>10 days, odds ratio [OR] = 2.37, 95% confidence interval [CI]:1.47-3.80), perioperative transfusion (OR = 2.15, 95% CI:1.45-3.18) and 90-day mortality (OR = 2.50, 95% CI:1.16-5.38). Median and 5-year overall survival (OS) for the entire cohort was 41.5 months (IQR:15.7-107.8) and 39.8%, respectively. Of note, median OS incrementally worsened with increased ALBI grade: grade 1, 49.6 months (IQR:18.3-NR) vs grade 2, 29.6 months (IQR:12.6-98.4) vs grade 3, 16.9 months (IQR:6.5-32.4; P < 0.001). On multivariable analysis, higher ALBI grade remained associated with higher hazards of death (grade 2/3: hazard ratio = 1.36, 95% CI:1.04-1.78). Conclusion: The ALBI score was associated with both short- and long-term outcomes following resection for ICC and could prove a useful surrogate marker to identify patients at risk for adverse outcomes. info:eu-repo/semantics/publishedVersion

Published
2019
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2. A New Tool to Predict Success Rate of Percutaneous Ablation for HCC: The Ablation Difficulty Score

Author

Bianco, A., primary, Conci, S., additional, D'Onofrio, M., additional, Campagnaro, T., additional, Martone, E., additional, De Bellis, M., additional, Longo, C., additional, Dedoni, S., additional, D'Addetta, M.V., additional, Bagante, F., additional, Ciangherotti, A., additional, Pedrazzani, C., additional, Dalbeni, A., additional, Guglielmi, A., additional, and Ruzzenente, A., additional

Published
2022
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4. ASO Visual Abstract

Author

Ruzzenente, A., Bagante, F., Olthof, P.B., Aldrighetti, L., Alikhanov, R., Cescon, M., Koerkamp, B.G., Jarnagin, W.R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Iacono, C., van Gulik, T.M., Guglielmi, A., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Campagnaro, T., Capobianco, I., Charco, R., de Reuver, P., de Savornin Lohman, E., Dejong, C.H.C., Efanov, M., Erdmann, J.I., Franken, L.C., Giovinazzo, G., Giglio, M.C., Gomez-Gavara, C., Heid, F., Ijzermans, J.N.M., Isaac, J., Jansson, H., Ligthart, M.A.P., Maithel, S.K., Malago, M., Malik, H.Z., Muiesan, P., Damink, S.W.M.O., Quinn, L.M., Ratti, F., Ravaioli, M., Rolinger, J., Schadde, E., Serenari, M., Troisi, R., van Laarhoven, S., van Vugt, J.L.A., Surgery, CCA - Cancer Treatment and Quality of Life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Intrahepatic, medicine.medical_specialty, business.industry, General surgery, MEDLINE, Cholangiocarcinoma, Collaborative group, Settore MED/18 - Chirurgia Generale, Oncology, Bile Duct Neoplasms, Surgical oncology, medicine, Humans, Surgery, Bile Ducts, Perihilar Cholangiocarcinoma, business, Bismuth, Bile Ducts, Intrahepatic, Klatskin Tumor
Published
2021
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5. Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Author

Ruzzenente, A., Bagante, F., Olthof, P.B., Aldrighetti, L., Alikhanov, R., Cescon, M., Koerkamp, B.Groot, Jarnagin, W.R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Reuver, P.R. de, Iacono, C., Gulik, T.M. van, Guglielmi, A., Ruzzenente, A., Bagante, F., Olthof, P.B., Aldrighetti, L., Alikhanov, R., Cescon, M., Koerkamp, B.Groot, Jarnagin, W.R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Reuver, P.R. de, Iacono, C., Gulik, T.M. van, and Guglielmi, A.

Abstract

Contains fulltext : 239075.pdf (Publisher’s version ) (Open Access), BACKGROUND: Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. METHODS: Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. RESULTS: Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). CONCLUSIONS: In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.

Published
2021

6. Resection of colorectal liver metastases: prognostic impact of tumor burden score varies according to unilobar versus bilobar metastatic spread

Author

Tsilimigras, D.I., primary, Hyer, J.M., additional, Guglielmi, A., additional, Ruzzenente, A., additional, Bagante, F., additional, Alexandrescu, S., additional, Poultsides, G., additional, Sasaki, K., additional, Aucejo, F., additional, Ejaz, A., additional, Cloyd, J.M., additional, and Pawlik, T.M., additional

Published
2021
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16. Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition

Author

Shah, R. Diaz, A. Tripepi, M. Bagante, F. Tsilimigras, D.I. Machairas, N. Sigala, F. Moris, D. Barreto, S.G. Pawlik, T.M.

Abstract

Background: There has been a dramatic increase in worldwide health care spending over the last several decades. Operative procedures and perioperative care in the USA represent some of the most expensive episodes per patient. In view of both the rising cost of health care in general and the rising cost of surgical care specifically, policymakers and stakeholders have sought to identify ways to increase the value—improving quality of care while controlling (or diminishing) costs. In this context, we reviewed data relative to achieving the “value proposition” in the delivery of gastrointestinal surgical care. Methods: The National Library of Medicine online repository (PubMed) was text searched for human studies including “cost,” “quality,” “outcomes,” “health care,” “surgery,” and “value.” Results from this literature framed by the Donabedian conceptual model (identifying structures, processes, and outcomes), and the resulting impact of efforts to improve quality on costs. Results: The relationship between quality and costs was nuanced. Better quality care, though associated with better outcomes, was not always reported as concomitant with low costs. Moreover, some centers reported higher costs of surgical care commensurate with higher quality. Conversely, higher costs in health care delivery were not always linked to improved outcomes. While higher quality surgical care can lead to lower costs, higher costs of care were not necessarily associated with better outcomes. Strategies to improve quality, reduce cost, or achieve both simultaneously included regionalization of complex operations to high-volume centers of excellence, overall reduction in complications, introducing evidence-based improvements in perioperative care pathways including as enhanced recovery after surgery (ERAS), and elimination of inefficient or low-value care. Conclusions: The relationship between quality and cost following gastrointestinal surgical procedure is complex. Data from the current study should serve to highlight the various means available to improve the value proposition related to surgery, as well as encourage surgeons to become more engaged in the national conversation around the Triple Aim of better health care quality, lower costs, and improved health care outcomes. © 2020, The Society for Surgery of the Alimentary Tract.

Published
2020

19. Correction to: Neuroendocrine Liver Metastasis: Prognostic Implications of Primary Tumor Site on Patients Undergoing Curative Intent Liver Surgery (Journal of Gastrointestinal Surgery, (2017), 21, 12, (2039-2047), 10.1007/s11605-017-3491-1)

Author

Spolverato, G., Bagante, F., Aldrighetti, L., Poultsides, G., Bauer, T. W., Fields, R. C., Marques, H. P., Weiss, M., Maithel, S. K., and Pawlik, T. M.

Subjects
PNET, Pancreatic neuroendocrine tumor, NELM, Surgery, Neuroendocrine liver metastasis
Published
2019

20. Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Author

Tsilimigras, D I, primary, Moris, D, additional, Hyer, J M, additional, Bagante, F, additional, Sahara, K, additional, Moro, A, additional, Paredes, A Z, additional, Mehta, R, additional, Ratti, F, additional, Marques, H P, additional, Silva, S, additional, Soubrane, O, additional, Lam, V, additional, Poultsides, G A, additional, Popescu, I, additional, Alexandrescu, S, additional, Martel, G, additional, Workneh, A, additional, Guglielmi, A, additional, Hugh, T, additional, Aldrighetti, L, additional, Endo, I, additional, Sasaki, K, additional, Rodarte, A I, additional, Aucejo, F N, additional, and Pawlik, T M, additional

Published
2020
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24. Parenchymal sparing versus anatomical hepatectomies in patients with multifocal (=4 tumors) colorectal liver metastasis: Results of an international multi-institutional analysis

Author

Bagante, F., primary, Ruzzenente, A., additional, Ratti, F., additional, Beal, E.W., additional, Alexandrescu, S., additional, Makris, E.A., additional, Poultsides, G.A., additional, Margonis, G.A., additional, Weiss, M.J., additional, Iacono, C., additional, Popescu, I., additional, Aldrighetti, L., additional, Guglielmi, A., additional, and Pawlik, T.M., additional

Published
2020
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25. Perihilar and distal extrahepatic cholangiocarcinomas show different genetic profiles but share MYC copy gain and TP53 mutation as independent poor prognostic markers

Author

Simbolo, M., primary, Mafficini, A., additional, Vicentini, C., additional, Ruzzenente, A., additional, Rusev, B., additional, Brunelli, M., additional, Pedron, S., additional, Bertuzzo, F., additional, Barbi, S., additional, Fassan, M., additional, Corbo, V., additional, Bagante, F., additional, Turri, G., additional, Luchini, C., additional, Lawlor, R., additional, Guglielmi, A., additional, Bassi, C., additional, and Scarpa, A., additional

Published
2019
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26. Impact of Morphological Status on Long-term Outcome Among Patients Undergoing Liver Surgery for Intrahepatic Cholangiocarcinoma

Author

Bagante, F., Spolverato, G., Weiss, M., Alexandrescu, S., Marques, H. P., Aldrighetti, L., Maithel, S. K., Pulitano, C., Bauer, T. W., Shen, F., Poultsides, G., Guglielmi, A., Marsh, J., Itaru, E., Koerkamp, B. Groot, Martel, G., Soubrane, O., Gamblin, T., Pawlik, T., Bagante, F, Spolverato, G, Weiss, M, Alexandrescu, S, Marques, Hp, Aldrighetti, L, Maithel, Sk, Pulitano, C, Bauer, Tw, Shen, F, Poultsides, G, Guglielmi, A, Marsh, J, Itaru, E, Koerkamp, Bg, Martel, G, Soubrane, O, Gamblin, T, and Pawlik, T

Published
2017

28. Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma

Author

Büttner, S. (Stefan), Ten Cate, D.W.G., Bagante, F, Alexandrescu, S., Marques, H.P., Lamelas, J., Aldrighetti, L., Gamblin, T.C., Maithel, SK, Pulitano, C., Margonis, GA, Weiss, M. (Melanie), Bauer, T.W., Shen, F., Poultsides, G.A., Marsh, J.W., IJzermans, J.N.M. (Jan), Pawlik, TM, Groot Koerkamp, B. (Bas), Büttner, S. (Stefan), Ten Cate, D.W.G., Bagante, F, Alexandrescu, S., Marques, H.P., Lamelas, J., Aldrighetti, L., Gamblin, T.C., Maithel, SK, Pulitano, C., Margonis, GA, Weiss, M. (Melanie), Bauer, T.W., Shen, F., Poultsides, G.A., Marsh, J.W., IJzermans, J.N.M. (Jan), Pawlik, TM, and Groot Koerkamp, B. (Bas)

Abstract

Background Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci. Methods Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ. Results One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90–1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48–2.64; p < 0.001). Conclusion Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5- year OS for resection of two tumors was 28.0%.

Published
2019
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29. Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma

Author

Buttner, Stefan, ten Cate, DWG (David), Bagante, F, Alexandrescu, S, Marques, HP, Lamelas, J, Aldrighetti, L, Gamblin, TC, Maithel, SK, Pulitano, C, Margonis, GA, Weiss, M, Bauer, TW, Shen, F, Poultsides, GA, Marsh, JW, IJzermans, J.N.M., Pawlik, TM, Groot Koerkamp, B, Buttner, Stefan, ten Cate, DWG (David), Bagante, F, Alexandrescu, S, Marques, HP, Lamelas, J, Aldrighetti, L, Gamblin, TC, Maithel, SK, Pulitano, C, Margonis, GA, Weiss, M, Bauer, TW, Shen, F, Poultsides, GA, Marsh, JW, IJzermans, J.N.M., Pawlik, TM, and Groot Koerkamp, B

Published
2019

30. Clinical significance and prognostic relevance of KRAS, BRAF, PI3K and TP53 genetic mutation analysis for resectable and unresectable colorectal liver metastases: A systematic review of the current evidence

Author

Tsilimigras, D.I. Ntanasis-Stathopoulos, I. Bagante, F. Moris, D. Cloyd, J. Spartalis, E. Pawlik, T.M.

Subjects
neoplasms
Abstract

Background: Hepatic resection is considered the optimal potentially curative treatment for colorectal liver metastases (CRLM). Following resection, up to two-thirds of patients will develop recurrence within 5-years. Genetic mutation analysis of CRLM, especially KRAS status, has been proposed as a means to guide treatment, as well as identifying patients who can derive the most survival benefit from hepatic resection. Methods: A systematic review of the literature was conducted the PubMed, Embase and Cochrane library through February 8th, 2018. The following algorithm was applied: “(colorectal OR rectal OR colon OR colonic) AND (liver OR hepatic) AND (metastasis OR metastases) AND (gene OR mutation OR KRAS OR BRAF OR SMAD4 OR RAS OR TP53 OR P53 OR APC OR PI3K OR MSI OR EGFR OR MACC1 OR microsatellite).” Results: From the 2404 records retrieved, 78 studies were finally deemed eligible; 47 studies reported mutational data on patients with resectable CRLM, whereas 31 studies reported on patients with unresectable CRLM. Mutational analyses were mostly performed on the CRLM specimen rather than the primary CRC. The vast majority of studies reported on the KRAS mutational status (88.5%, n = 69/78). Prevalence of KRAS mutations ranged from 25% to 52%. Most studies reported that RAS mutation was a negative prognostic factor for overall (OS) (n = 24) and recurrence-free (RFS) (n = 9) survival; a few reports noted no effect of RAS mutational status on OS (n = 4) or RFS (n = 6). Twelve studies reported on BRAF mutations with a prevalence of BRAF mutation ranging from 0 to 9.1% in resected CRLM specimens. BRAF mutation was strongly associated with a worse prognosis. TP53 and PIK3CA gene mutations did not affect long-term outcomes. Conclusions: The biological status of each tumor provides the basis for individualized cancer therapeutics. Data on the mutational status on CRLM should be a part of multidisciplinary discussions to help inform the therapeutic approach, type of chemotherapy, as well as timing and approach of surgical resection. © 2018 Elsevier Ltd

Published
2018

32. A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma

Author

Vitale A, Spolverato G, Bagante F, Gani F, Popescu I, Marques HP, Aldrighetti L, Gamblin TC, Maithel SK, Sandroussi C, Bauer TW, Shen F, Poultsides GA, Marsh JW, Pawlik TM, Vitale, A, Spolverato, G, Bagante, F, Gani, F, Popescu, I, Marques, Hp, Aldrighetti, L, Gamblin, Tc, Maithel, Sk, Sandroussi, C, Bauer, Tw, Shen, F, Poultsides, Ga, Marsh, Jw, and Pawlik, Tm

Abstract

BackgroundLittle is known regarding postoperative outcomes of elderly patients undergoing liver surgery for intrahepatic cholangiocarcinoma (ICC). MethodsFive hundred and eighty-four patients undergoing liver resection for ICC between 1990 and 2015 were identified. Perioperative morbidity, mortality, overall survival (OS), and disease-free survival (DFS) were compared between elderly (>70 year, n=129) and non-elderly (70 years, n=455) patients. ResultsOlder patients had a higher incidence of complications (elderly vs. non-elderly; 52.7% vs. 42.6%; P=0.03), as well as major complications (elderly vs. non-elderly; 24.0% vs. 14.9%; P=0.01); 30-day (0.1% vs. 3.3%; P>0.05), and 90-day mortality (2.3% vs. 5.5%; P>0.05) were comparable. Five-year OS and DFS were comparable between the elderly and non-elderly patients (OS, 13.3% vs. 24.4%; and DFS; 7.3% vs. 12.0%; P>0.05). On propensity score matching, DFS and OS were also comparable among non-elderly versus elderly patients. Poor tumor grade was associated with worse DFS among elderly patients (HR=1.6, 95%CI 1.0-2.6; P=0.04), whereas periductal invasion (HR=1.9, 95% CI 1.1-3.5; P=0.03) and nodal disease (HR=2.3, 95% CI 1.3-3.9; P=0.003) were predictive of shorter DFS among non-elderly patients. ConclusionElderly patients undergoing liver surgery for ICC demonstrated an increased risk of perioperative complications, but comparable long-term DFS and OS compared with younger patients. Rather, tumor characteristics were more predictive of worse long-term outcomes. J. Surg. Oncol. 2016;113:420-426. (c) 2016 Wiley Periodicals, Inc.

Published
2016

35. Evaluating the prognostic nutrition index in pancreatic neuroendocrine tumor: results from the neuroendocrine tumor study group

Author

Beal, E.W., primary, Bagante, F., additional, Lopez-Aguiar, A.G., additional, Poultsides, G., additional, Makris, E., additional, Rocha, F., additional, Kanji, Z., additional, Kelley, S.R., additional, Barrett, J.R., additional, Fields, R.C., additional, Krasnick, B.A., additional, Idrees, K., additional, Smith, P Marincola, additional, Cho, C.S., additional, Beems, M.V., additional, Maithel, S.K., additional, Schmidt, C.R., additional, Pawlik, T.M., additional, and Dillhoff, M., additional

Published
2019
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37. AJCC 8th edition staging system for intrahepatic cholangiocarcinoma: an analysis of 1,154 patients undergoing hepatectomy with curative intent

Author

Bagante, F., primary, Spolverato, G., additional, Weiss, M., additional, Alexandrescu, S., additional, Marques, H.P., additional, Aldrighetti, L., additional, Maithel, S.K., additional, Pulitano, C., additional, Bauer, T.W., additional, Shen, F., additional, Poultsides, G.A., additional, Soubrane, O., additional, Martel, G., additional, Koerkamp, B.G., additional, Itaru, E., additional, Guglielmi, A., additional, and Pawlik, T.M., additional

Published
2019
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38. A Novel Clinical Score Including Future Liver Remnant Volume and Indocyanine Green Retention Test to Predict Post-hepatectomy Liver Failure

Author

Bagante, F., primary, Ruzzenente, A., additional, Russolillo, N., additional, Dorna, A., additional, Valcanover, S., additional, Langella, S., additional, Campagnaro, T., additional, Conci, S., additional, Bertuzzo, F., additional, Iacono, C., additional, Ferrero, A., additional, and Guglielmi, A., additional

Published
2019
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48. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma

Author

Zhang, X -F, primary, Chakedis, J, additional, Bagante, F, additional, Chen, Q, additional, Beal, E W, additional, Lv, Y, additional, Weiss, M, additional, Popescu, I, additional, Marques, H P, additional, Aldrighetti, L, additional, Maithel, S K, additional, Pulitano, C, additional, Bauer, T W, additional, Shen, F, additional, Poultsides, G A, additional, Soubrane, O, additional, Martel, G, additional, Groot Koerkamp, B, additional, Guglielmi, A, additional, Itaru, E, additional, and Pawlik, T M, additional

Published
2018
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49. A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma

Author

Vitale, A, Spolverato, G, Bagante, F, Gani, F, Popescu, I, Pinto Marques, H, Aldrighetti, L, Gamblin, TC, Maithel, S, Sandroussi, C, Bauer, T, Shen, F, Poultsides, G, Marsh, J, and Pawlik, T

Subjects
Male, Databases, Factual, elderly, hepatectomy, intrahepatic cholangiocarcinoma, liver resection, surgery, Age Factors, Kaplan-Meier Estimate, Middle Aged, HCC CIR, humanities, Disease-Free Survival, Cholangiocarcinoma, Logistic Models, Bile Duct Neoplasms, Hepatectomy, Humans, Female, Aged
Abstract

BACKGROUND: Little is known regarding postoperative outcomes of elderly patients undergoing liver surgery for intrahepatic cholangiocarcinoma (ICC). METHODS: Five hundred and eighty-four patients undergoing liver resection for ICC between 1990 and 2015 were identified. Perioperative morbidity, mortality, overall survival (OS), and disease-free survival (DFS) were compared between elderly (>70 year, n = 129) and non-elderly (≤70 years, n = 455) patients. RESULTS: Older patients had a higher incidence of complications (elderly vs. non-elderly; 52.7% vs. 42.6%; P = 0.03), as well as major complications (elderly vs. non-elderly; 24.0% vs. 14.9%; P = 0.01); 30-day (0.1% vs. 3.3%; P > 0.05), and 90-day mortality (2.3% vs. 5.5%; P > 0.05) were comparable. Five-year OS and DFS were comparable between the elderly and non-elderly patients (OS, 13.3% vs. 24.4%; and DFS; 7.3% vs. 12.0%; P > 0.05). On propensity score matching, DFS and OS were also comparable among non-elderly versus elderly patients. Poor tumor grade was associated with worse DFS among elderly patients (HR = 1.6, 95%CI 1.0-2.6; P = 0.04), whereas periductal invasion (HR = 1.9, 95% CI 1.1-3.5; P = 0.03) and nodal disease (HR = 2.3, 95% CI 1.3-3.9; P = 0.003) were predictive of shorter DFS among non-elderly patients. CONCLUSION: Elderly patients undergoing liver surgery for ICC demonstrated an increased risk of perioperative complications, but comparable long-term DFS and OS compared with younger patients. Rather, tumor characteristics were more predictive of worse long-term outcomes. info:eu-repo/semantics/publishedVersion

Published
2016

50. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent

Author

Zhang, X -F, primary, Beal, E W, additional, Bagante, F, additional, Chakedis, J, additional, Weiss, M, additional, Popescu, I, additional, Marques, H P, additional, Aldrighetti, L, additional, Maithel, S K, additional, Pulitano, C, additional, Bauer, T W, additional, Shen, F, additional, Poultsides, G A, additional, Soubrane, O, additional, Martel, G, additional, Koerkamp, B G, additional, Itaru, E, additional, and Pawlik, T M, additional

Published
2017
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