Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Abstract

Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

Proposal of a New Definition of “Very Early” Intrahepatic Cholangiocarcinoma—A Retrospective Single-Center Analysis

“…Recently, inflammation-based biomarkers have been shown to have prognostic value in patients with ICC [ 19 ]. Accordingly, we previously identified preoperative leukocytosis as an independent risk factor for survival after resection of ICC and proposed malnutrition and dehydration, cholangitis due to cholestasis, as well as a systemic reaction to a more aggressive tumor biology as explanations for our findings [ 5 ]. In line with these results, we observed significantly lower levels of preoperative leukocyte concentrations in patients undergoing resection of “very early” ICC.…”

“…Recent epidemiological data revealed a rising incidence; however, ICC remains a rarity, especially compared to hepatocellular carcinoma [ 2 ]. Although there is a lack of large clinical studies to identify patients, which benefit most from surgical resections, several prognostic factors for postoperative survival have been identified in the past, including multifocality, vascular invasion, lymph node involvement, and type of liver resection [ 3 , 4 , 5 , 6 , 7 ]. The tumor diameter itself as a prognostic factor has been a matter of debate: while the first staging system of the American Joint Committee on Cancer (AJCC) did not include tumor size, the 8th edition of the AJCC(/UICC) defines stage IA and IB depending on a maximum tumor size of 5 cm [ 8 , 9 ].…”

Evaluation of Postoperative Complication with Medically Necessary, Time-Sensitive Scoring System During Acute COVID-19 Pandemic: A Prospective Observational Study

“…Regarding abnormal preoperative laboratory evaluations, leukocytosis is long associated with perioperative complications, morbidity and mortality in colorectal, hepatic, ovarian and cervical disc surgeries. 34 , 35 , 36 , 37 Likewise preoperative elevated CRP is associated with higher morbidity and mortality in abdominal and thoracic cancer surgical patients. 38 There is scant evidence on the possible role of preoperative lymphopenia on postoperative complications.…”

Impact of preoperative white blood cell count on long-term outcome in patients undergoing surgery for colorectal cancer: A retrospective observational study of Chinese patients

“…A meta-analysis showed that preoperative leukocytosis was common and correlates with poor pathological and survival outcomes in endometrial carcinoma patients 23 . A study showed that preoperative leukocytosis and the resection severity index were independent risk factors for survival in patients with intrahepatic cholangiocarcinoma 24 . Cancer patients with acute venous thromboembolism and elevated WBC count had an increased incidence of VTE recurrences, major bleeding, or death 25 .…”