Liver resection in elderly patients with extensive CRLM: Are we offering an adequate treatment? A propensity score matched analysis

Martino, Marcello Di; Dorcaratto, Dimitri; Primavesi, Florian; Syn, Nicholas; Blanco-Terés, Lara; Dupré, Aurélien; Piardi, Tullio; Rhaiem, Rami; Fernández, Gerardo Blanco; Conde, N. De Armas; Sanjuán, Juan Carlos Rodríguez; Santiago, Roberto; Fernández‐Moreno, María‐Carmen; Ferret, Georgina; Ben, Santiago López; Muñóz, Miguel Ángel Suárez; Pérez-Alonso, Alejandro J.; Koh, Ye‐Xin; Jones, Robert; Vennarecci, Giovanni; Martín-Pérez, Elena

doi:10.1016/j.ejso.2021.12.028

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…Hemihepatic and triple resection are the most commonly used surgical approaches for hilar CCA, with the advantages of easy access to R0 resection, absence of large hepatic branches in the liver section, a relatively small number of bile duct openings [1][2], and simpler biliary anastomosis (27). Several studies have confirmed the safety and effectiveness of extensive hepatic resection (28)(29)(30). Therefore, if the condition allows, choosing a wide range of hepatectomy can effectively reduce the number of biliary anastomoses and the difficulty of biliary anastomosis, thereby reducing the risk of biliary fistula, especially clinically relevant biliary fistula after surgery for PHCC.…”

Section: Discussionmentioning

confidence: 99%

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study

Yin¹,

Xu²,

Yin³

et al. 2023

J Gastrointest Oncol

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Background: Nowadays, the incidence of perihilar cholangiocarcinoma (PHCC) is increasing yearly, and biliary fistula is a common complication. However, there are few reports on the factors affecting the occurrence of biliary fistula. This study aimed to analyze the risk factors for the occurrence of biliary fistula after radical surgery for PHCC in elderly patients to provide a reference basis for improving the prognosis. Methods:From April 2016 to April 2021, we randomly included 250 elderly patients with pathologically diagnosed PHCC. Based on our established inclusion and exclusion criteria, we included 211 patients finally Bile drainage for 3 consecutive days after abdominal drainage or single bile drainage ≥100 mL/d was used as the diagnostic criteria for biliary fistula. Multiple logistic regression was used to analyze the independent risk factors for biliary fistula after radical surgery for PHCC. Besides, the Prognostic Score (PS), the Karnofsky performance score (KPS), and the quality of life (QOL) score were used to assess the patients' postoperative recovery, and survival curves were drawn to reflect their 1-year survival rate, using overall survival. Results:The statistical results showed a 36.5% incidence of biliary fistula. Our study showed that preoperative cholangitis, number of biliary anastomoses, etc. were independent risk factors for grade B and grade C biliary fistula. Besides, the presence of intraoperative hemorrhage (OR =0.223, P=0.006) and γ-glutamyl transpeptidase (γ-GT) on the first postoperative day (OR =1.011, P=0.013) were still independent risk factors for grade B biliary fistula, while C-reactive protein (CRP) (OR =1.026, P=0.011) and total bilirubin (TBil) (OR =0.003, P=1.066) on the first postoperative day and bile duct diameter (OR =0.299, P=0.020) were independent risk factors for grade C biliary fistula. Analysis of variance (ANOVA) showed statistically significant differences (P<0.05) between the three groups in terms of PS (P=0.000), KPS (P=0.001), and QOL scores (P=0.000). Conclusions:The incidence of postoperative biliary fistula remains high in elderly patients treated with radical surgery for PHCC and seriously affects their prognosis. Therefore, focusing on the clinical characteristics and risk factors of patients, improving surgical precision and enhancing postoperative patient care to reduce the likelihood of postoperative biliary fistula, thereby prolonging patient life.

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Section: Discussionmentioning

confidence: 99%

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study

Yin¹,

Xu²,

Yin³

et al. 2023

J Gastrointest Oncol

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Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis

Terrone,

Di Martino,

Saeidi

et al. 2024

Updates Surg

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The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

Đorđić,

Bogdanović,

Zdujić

et al. 2024

Medicinska istraživanja

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Introduction: The prognostic value of the age-adjusted Charlson comorbidity index (ACCI) for patients with colorectal liver metastases (CRLM) undergoing liver resection is still unclear. The aim of this study is to analyze the impact of ACCI in the prediction of shortand longterm outcomes after liver resection in patients with CRLM. Material and methods: Data related to 101 patients who underwent liver resection for CRLM at the University Clinic for Digestive Surgery between October 2019 and October 2022 were analyzed in this cohort retrospective study. ACCI was determined according to an established point scale. Patients were further divided into two groups: group 1, ACCI <7, and group 2, ACCI ≥7. Results: There was no statistically significant difference in the length of postoperative ICU stay (p=0.9670), semi-ICU stay (p=0.627), and hospital stay (p=0.243). Overall morbidity was higher in group 1 (60%) than in group 2 (39.3), p=0.042, while major morbidity (grade ≥3) was similar between groups, p=0.127. Biliary fistula was more common in group 1 compared to group 2 (12.5% vs 1.6%), p=0.035. In-hospital mortality, 30-day, and 90-day mortality were similar between the study groups (p=1; p=0.517 and p=0.517). During the follow-up period, recurrence was registered in 48.5% of patients. There was no difference in recurrence-free survival between groups, p=0.430. The overall survival was similar between the groups, p=0.141. Conclusion: ACCI can be used to predict postoperative morbidity after liver resection for CRLM. The postoperative mortality and recurrence-free survival are similar regardless of age and comorbidity.

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Liver resection in elderly patients with extensive CRLM: Are we offering an adequate treatment? A propensity score matched analysis

Cited by 3 publications

References 29 publications

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study

Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis

The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

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