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The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma
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 th...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695871/ https://www.ncbi.nlm.nih.gov/pubmed/37899413 http://dx.doi.org/10.1245/s10434-023-14419-x |
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author | van Keulen, Anne-Marleen Olthof, Pim B. Buettner, Stefan Bednarsch, Jan Verheij, Joanne Erdmann, Joris I. Nooijen, Lynn E. Porte, Robert J. Minnee, Robert C. Murad, Sarwa Darwish Neumann, Ulf P. Heij, Lara Groot Koerkamp, Bas Doukas, Michail |
author_facet | van Keulen, Anne-Marleen Olthof, Pim B. Buettner, Stefan Bednarsch, Jan Verheij, Joanne Erdmann, Joris I. Nooijen, Lynn E. Porte, Robert J. Minnee, Robert C. Murad, Sarwa Darwish Neumann, Ulf P. Heij, Lara Groot Koerkamp, Bas Doukas, Michail |
author_sort | van Keulen, Anne-Marleen |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-023-14419-x. |
format | Online Article Text |
id | pubmed-10695871 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-106958712023-12-06 The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma van Keulen, Anne-Marleen Olthof, Pim B. Buettner, Stefan Bednarsch, Jan Verheij, Joanne Erdmann, Joris I. Nooijen, Lynn E. Porte, Robert J. Minnee, Robert C. Murad, Sarwa Darwish Neumann, Ulf P. Heij, Lara Groot Koerkamp, Bas Doukas, Michail Ann Surg Oncol Hepatobiliary Tumors 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-023-14419-x. Springer International Publishing 2023-10-29 2024 /pmc/articles/PMC10695871/ /pubmed/37899413 http://dx.doi.org/10.1245/s10434-023-14419-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Hepatobiliary Tumors van Keulen, Anne-Marleen Olthof, Pim B. Buettner, Stefan Bednarsch, Jan Verheij, Joanne Erdmann, Joris I. Nooijen, Lynn E. Porte, Robert J. Minnee, Robert C. Murad, Sarwa Darwish Neumann, Ulf P. Heij, Lara Groot Koerkamp, Bas Doukas, Michail The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title | The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title_full | The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title_fullStr | The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title_full_unstemmed | The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title_short | The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma |
title_sort | influence of hepatic steatosis and fibrosis on postoperative outcomes after major liver resection of perihilar cholangiocarcinoma |
topic | Hepatobiliary Tumors |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695871/ https://www.ncbi.nlm.nih.gov/pubmed/37899413 http://dx.doi.org/10.1245/s10434-023-14419-x |
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