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The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma

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Abstract

The term “failure to rescue” (FTR) has been recently introduced in the field of hepato-biliary surgery to label cases in which major postoperative complications lead to postoperative fatality. Perihilar cholangiocarcinoma (PHC) surgery has consistently high postoperative morbidity and mortality rates in which factors associated with FTR are yet to be discovered. The primary endpoint of this study is to compare the Rescue with the FTR cohort referencing patients’ characteristics and management protocols applied. A cohort of 224 consecutive patients undergoing surgery for PHC, between 2010 and 2021, was enrolled. Perioperative variables were analyzed according to the severity of major postoperative complications (Clavien ≥ 3a). Kaplan–Meier survival analyses were performed to determine complications’ impact on survival. Major complications were reported in 86 cases (38%). Among the major complications’ cohort, 72 cases (84%) were graded Clavien 3a–4 (Rescue group), while 14 (16%) cases were graded Clavien 5 (FTR group). Number of lymph-node metastases (OR = 1.33 (1.08–1.63) p = 0.006), poorly differentiated (G3) adenocarcinoma (OR = 7.55 (1.24–45.8) p = 0.028, reintervention (OR = 16.47 (2.76–98.08) p = 0.002), and prognostic nutritional index < 40 (OR = 3.01 (2.265–3.654) p < 0.001) rates were independent predictors of FTR. Right resection side (OR 2.4 (1.33–4.34) p = 0.004) increased the odds of major complications but not of FTR. No difference in overall survival was identified. A distinction of perioperative factors associated with postoperative complications’ severity is crucial. Patients developing severe outcomes seem to have different biological and nutritional profiles, showing that efficient preoperative protocols are strategic to identify and avert the risk of FTR.

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Abbreviations

FTR:

Failure to rescue

PHC:

Perihilar cholangiocarcinoma

ASA:

American Society of Anesthesiologists

OR:

Odds ratio

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Author notes

  1. Francesca Ratti and Rebecca Marino share first authorship.

  2. Francesco De Cobelli and Luca Aldrighetti share senior authorship.

Authors and Affiliations

  1. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy

    Francesca Ratti, Rebecca Marino, Marco Catena, Marco Maria Pascale, Silvia Buonanno & Luca Aldrighetti

  2. Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy

    Francesco De Cobelli

  3. Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Francesco De Cobelli

  4. Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy

    Luca Aldrighetti

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Ratti, F., Marino, R., Catena, M. et al. The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma. Updates Surg 75, 1919–1939 (2023). https://doi.org/10.1007/s13304-023-01589-2

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