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2. Correction to: Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma (Annals of Surgical Oncology, (2020), 10.1245/s10434-020-08258-3)

Author

Olthof P. B., Aldrighetti L., Alikhanov R., Cescon M., Groot Koerkamp B., Jarnagin W. R., Nadalin S., Pratschke J., Schmelzle M., Sparrelid E., Lang H., Guglielmi A., van Gulik T. M., Andreou A., Bartsch F., Benzing C., Buettner S., Capobianco I., de Reuver P., de Savornin Lohman E., Dejong C. H. C., Efanov M., Erdmann J. I., Franken L. C., Frascaroli G., Giglio M. C., Gomez-Gavara C., Heid F., IJzermans J. N. M., Jansson H., Ligthart M. A. P., Maithel S. K., Malago M., Malik H. Z., Muiesan P., Olde Damink S. W. M., Pando E., Quinn L. M., Ratti F., Roberts K. J., Rolinger J., Ruzzenente A., Schadde E., Serenari M., Sultana A., Troisi R., van Laarhoven S., van Vugt J. L. A., Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Abstract

In the original article Moritz Schmelzle’s last name is spelled wrong. It is correct as reflected here.

Published
2020

3. Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Author

Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., IJzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., van Vugt, J. L. A., Surgery, Academic Medical Center, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, education, 030230 surgery, Preoperative care, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Preoperative Care, medicine, Hepatectomy, Humans, Embolization, Abscess, Bile Duct Neoplasm, Aged, Retrospective Studies, portal vein embolization, portal vein embolisation, Perihilar cholangiocarcinoma, Portal Vein, business.industry, Incidence (epidemiology), Liver Neoplasms, Correction, Retrospective cohort study, Middle Aged, Jaundice, medicine.disease, Embolization, Therapeutic, Surgery, Bile Duct Neoplasms, Oncology, Liver Neoplasm, Hepatobiliary Tumors, 030220 oncology & carcinogenesis, Propensity score matching, Cohort, medicine.symptom, business, Liver Failure, Human, Klatskin Tumor
Abstract

Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p p p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

Published
2020

5. Outcome after resection for perihilar cholangiocarcinoma in patients with primary sclerosing cholangitis: an international multicentre study

Author

F. Bartsch, J. Hagendoorn, R. Charco, Q.I. Molenaar, Hauke Lang, A. Sultana, F. Heid, J.I. Erdmann, Erik Schadde, G. Kazemier, H.Z. Malik, J. Rolinger, Stefan Buettner, C.L.M. Nota, Andrea Ruzzenente, M.C. Giglio, Mikhail Efanov, Shishir K. Maithel, P. Muiesan, M. Ravaioli, K.J. Roberts, I. Capobianco, Thomas M. van Gulik, J. van Vugt, Ruslan Alikhanov, Hannes Jansson, A. Andreou, Alfredo Guglielmi, Johann Pratschke, M. Malago, Moritz Schmelzle, E. de Savornin Lohman, Silvio Nadalin, Marjolein A P Ligthart, P.R. de Reuver, Bas Groot Koerkamp, S. W. M. Olde Damink, L.E. Nooijen, Francesca Ratti, S. van Laarhoven, C. Gomez-Gavara, B.M. Zonderhuis, C. Benzing, Matteo Serenari, Luca Aldrighetti, L.C. Franken, Annika Bergquist, Cornelis H. C. Dejong, Ernesto Sparrelid, Matteo Cescon, William R. Jarnagin, L.M. Quinn, Pim B. Olthof, J.N.M. IJzermans, Roberto Troisi, RS: NUTRIM - R2 - Liver and digestive health, Surgery, MUMC+: MA Heelkunde (9), Jansson, H., Olthof, P. B., Bergquist, A., Ligthart, M. A. P., Nadalin, S., Troisi, R, Groot Koerkamp, B., Alikhanov, R., Lang, H., Guglielmi, A., Cescon, M., Jarnagin, W. R., Aldrighetti, L., van Gulik, T. M., Sparrelid, E., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., Charco, R., de Reuver, P. R., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Giglio, M. C., Gomez-Gavara, C., Hagendoorn, J., Heid, F., Ijzermans, J. N. M., Kazemier, G., Maithel, S. K., Malago, M., Malik, H. Z., Molenaar, Q. I., Muiesan, P., Nooijen, L. E., Nota, C. L. M., Olde Damink, S. W. M., Pratschke, J., Quinn, L. M., Ratti, F., Ravaioli, M., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Schmelzle, M., Serenari, M., Sultana, A., van Laarhoven, S., van Vugt, J. L. A., Zonderhuis, B. M., Troisi, R. I., CCA - Cancer Treatment and Quality of Life, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
medicine.medical_specialty, endocrine system diseases, Cholangitis, Cholangitis, Sclerosing, 030230 surgery, HILAR CHOLANGIOCARCINOMA, Gastroenterology, digestive system, Article, Sclerosing, Resection, Primary sclerosing cholangitis, Cholangiocarcinoma, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Primary outcome, Internal medicine, Overall survival, medicine, Humans, In patient, Perihilar Cholangiocarcinoma, Retrospective Studies, Intrahepatic, RISK, Hepatology, business.industry, digestive, oral, and skin physiology, Retrospective cohort study, medicine.disease, digestive system diseases, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, Postoperative mortality, 030220 oncology & carcinogenesis, Bile Ducts, business, Klatskin Tumor
Abstract

Contains fulltext : 245473.pdf (Publisher’s version ) (Open Access) BACKGROUND: Resection for perihilar cholangiocarcinoma (pCCA) in primary sclerosing cholangitis (PSC) has been reported to lead to worse outcomes than resection for non-PSC pCCA. The aim of this study was to compare prognostic factors and outcomes after resection in patients with PSC-associated pCCA and non-PSC pCCA. METHODS: The international retrospective cohort comprised patients resected for pCCA from 21 centres (2000-2020). Patients operated with hepatobiliary resection, with pCCA verified by histology and with data on PSC status, were included. The primary outcome was overall survival. Secondary outcomes were disease-free survival and postoperative complications. RESULTS: Of 1128 pCCA patients, 34 (3.0%) had underlying PSC. Median overall survival after resection was 33 months for PSC patients and 29 months for non-PSC patients (p = .630). Complications (Clavien-Dindo grade ≥ 3) were more frequent in PSC pCCA (71% versus 44%, p = .003). The rate of posthepatectomy liver failure (21% versus 17%, p = .530) and 90-day mortality (12% versus 13%, p = 1.000) was similar for PSC and non-PSC patients. CONCLUSION: Median overall survival after resection for pCCA was similar in patients with underlying PSC and non-PSC patients. Complications were more frequent after resection for PSC-associated pCCA, with no difference in postoperative mortality.

Published
2021

6. Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Author

Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou A, Bartsch F, Benzing C, Buettner S, Campagnaro T, Capobianco I, Charco R, de Reuver P, de Savornin, Lohman E, Nijmegen, Dejong CHC, Efanov M, Erdmann JI, Franken LC, Giovinazzo G, Giglio MC, Gomez-Gavara C, Heid F, IJzermans JNM, Isaac J, Jansson H, Ligthart MAP, Maithel SK, Malago` M. Malik HZ, Muiesan P, Olde Damink SWM, Quinn LM, Ratti F, Ravaioli M, Rolinger J, Schadde E, Serenari M, Troisi R, van Laarhoven S, van Vugt JLA, Faculteit Medische Wetenschappen/UMCG, Surgery, Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou, A, Bartsch, F, Benzing, C, Buettner, S, Campagnaro, T, Capobianco, I, Charco, R, de Reuver, P, De, Savornin, Lohman, E, Nijmegen, Dejong, Chc, Efanov, M, Erdmann, Ji, Franken, Lc, Giovinazzo, G, Giglio, Mc, Gomez-Gavara, C, Heid, F, Ijzermans, Jnm, Isaac, J, Jansson, H, Ligthart, Map, Maithel, Sk, Malago` M., Malik HZ, Muiesan, P, Olde Damink, Swm, Quinn, Lm, Ratti, F, Ravaioli, M, Rolinger, J, Schadde, E, Serenari, M, Troisi, R, van Laarhoven, S, van Vugt, Jla, 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., CCA - Cancer Treatment and Quality of Life, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
medicine.medical_specialty, medicine.medical_treatment, Perineural invasion, Metastasis, Cholangiocarcinoma, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Surgical oncology, Medicine, Hepatectomy, Humans, Perihilar Cholangiocarcinoma, Contraindication, Retrospective Studies, business.industry, Incidence (epidemiology), medicine.disease, Surgery, Oncology, Bile Duct Neoplasms, Cohort, business, Bismuth, Klatskin Tumor
Abstract

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
2020

7. Defining enhanced recovery after resection of peri-hilar cholangiocarcinoma.

Author

Quinn LM, Mann K, Jones RP, Bathla S, Stremitzer S, Dunne DF, Lacasia C, Fenwick SW, and Malik HZ

Subjects
Aged, Bile Duct Neoplasms diagnostic imaging, Bile Duct Neoplasms pathology, Cohort Studies, Disease-Free Survival, Female, Hepatectomy adverse effects, Hospitals, University, Humans, Klatskin Tumor diagnostic imaging, Klatskin Tumor pathology, Length of Stay, Male, Middle Aged, Neoplasm Invasiveness pathology, Neoplasm Staging, Patient Readmission, Perioperative Care methods, Postoperative Complications mortality, Postoperative Complications physiopathology, Precision Medicine methods, Prognosis, Retrospective Studies, Risk Assessment, Statistics, Nonparametric, Survival Analysis, Treatment Outcome, United Kingdom, Bile Duct Neoplasms mortality, Bile Duct Neoplasms surgery, Early Ambulation methods, Hepatectomy methods, Klatskin Tumor mortality, Klatskin Tumor surgery
Abstract

Introduction: Enhanced recovery after surgery (ERAS) for peri-hilar cholangiocarcinoma (pCCA) has not been described in the literature. This study examined patients undergoing pCCA resection within a standard post hepatectomy ERAS pathway to define achievable targets suitable for these patients., Methods: Patients undergoing pCCA resection at University Hospital Aintree (January 2009-October 2017) were identified. Achievement of key ERAS outcomes was assessed. Patients were stratified on incidence of major complications and pre-operative cardiopulmonary exercise testing. Chi Square and Mann Whitney analyses were undertaken as appropriate. Achievable ERAS targets were derived from patients who did not develop a major complication., Results: 46 patients underwent resection with enhanced recovery. Median age 65 (24 male: 22 female). Key ERAS outcomes in patients who did not experience major complications are described as medians (interquartile range): length of stay 8 days (6-13), duration critical care 2 days (2-4), inotropes 6 h (0-24), epidural 3 days (3-4), early mobilization day 1 (1-2), full mobilization day 3 (3-4), urinary catheter removal day 4 (3-5), NGT removal day 1 (1-2) and restoration oral nutrition day 2 (2-4). Patients deemed high risk pre-operatively or those who developed major complications post-operatively required significantly longer critical care (p = 0.008 and p = 0.002 respectively). Other ERAS targets remained achievable in similar timeframes., Conclusions: ERAS for pCCA is achievable. Applicable ERAS standards are defined which take into account minor complications. High risk patients and those with major complications can be appropriately managed in an ERAS pathway, though there is increased need for critical care support., (Copyright © 2019. Published by Elsevier Ltd.)

Published
2019
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