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Personalized Preoperative Nomograms Predicting Postoperative Risks after Resection of Perihilar Cholangiocarcinoma

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Abstract

Introduction

Curative treatment of perihilar tumors requires major hepatectomy responsible for high morbidity and mortality. Current nomograms are based on definitive pathological analysis, not usable for patient selection. Our aim was to propose preoperative predictors for severe morbidity (Dindo–Clavien ≥3) and mortality at sixth month after resection of perihilar tumors.

Patients and methods

We reviewed perioperative data of 186 patients operated with major hepatectomy for perihilar tumors between 2012 and 2018 in two high-volume centers. Univariate and multivariate analysis were performed to determine the preoperative predictors of morbidity and mortality. A stepwise regression in forward direction was developed to select variables for definitive models. Hosmer–Lemeshow test, Akaike information criteria and area under the ROC curves were calculated to validate both nomograms.

Results

Resections were indicated for perihilar and intrahepatic cholangiocarcinoma in 125 and 61 cases, respectively. Severe complications occurred in 76 patients (40.8%). Nineteen patients (10.2%) deceased before the sixth postoperative month. The predictors of severe morbidity were: male gender, portal vein embolization, planned biliary resection, low psoas muscle area/height2 and low hemoglobinemia. The predictors of early mortality were: age, high bilirubinemia, hypoalbuminemia, biliary drainage and long drainage-to-surgery interval.

For both models, the p values of Hosmer–Lemeshow tests were of 0.9 and 0.99, respectively, the Akaike information criteria were of 35.5 and 37.7, respectively, and area under the curves was of 0.73 and 0.86, respectively.

Conclusion

We developed two accurate and practical nomograms based on exclusively preoperative data to predict early outcomes following the resection of perihilar tumors. If validated in larger series, these tools could be integrated in the decision-making process for patient selection.

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Abbreviations

ASA:

American Society of Anesthesiologists

AUC:

Area under the curve

BSA:

Body surface area

FLR:

Future liver remnant

ICC:

Intrahepatic cholangiocarcinoma

IMAC:

Intramuscular adipose tissue content

NLR:

Neutrophil-to-lymphocyte ratio

PBD:

Preoperative biliary drainage

PHCC:

Perihilar cholangiocarcinoma

PHT:

Perihilar tumor

PLR:

Platelet-to-lymphocyte ratio

PMA:

Psoas muscle area

POD:

Postoperative day

ROC:

Receiving operating characteristic (curve)

SD:

Standard deviation

PVE:

Portal vein embolization

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Authors and Affiliations

  1. Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France

    Nicolas Golse, Julio Nunez, Ahmed Abdelrafee, Antonio Sa Cunha, Daniel Cherqui, René Adam & Eric Vibert

  2. FHU Hepatinov, 94800, Villejuif, France

    Nicolas Golse, Antonio Sa Cunha, Daniel Cherqui, René Adam & Eric Vibert

  3. Physiopathogénèse et Traitement des Maladies du Foie, Inserm, Université Paris-Saclay, UMR-S 1193, Villejuif, France

    Nicolas Golse, Antonio Sa Cunha, Daniel Cherqui & Eric Vibert

  4. Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France

    Alessandro Mazzotta, Damien Bergeat, Laurent Sulpice, Heithem Jeddou & Karim Boudjema

  5. Nutrition Metabolism and Cancer, INRA, INSERM, Unit 991, CHU Rennes, Univ Rennes, Univ Bretagne Loire, Rennes, France

    Luis Cano

  6. INSERM, Unit 985, 94800, Villejuif, France

    René Adam

  7. Univ Paris-Sud, UMR-S 985, 94800, Villejuif, France

    René Adam

  8. Centre Hépato-Biliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94804, Villejuif, France

    Nicolas Golse

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  1. Nicolas Golse
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Golse, N., Nunez, J., Mazzotta, A. et al. Personalized Preoperative Nomograms Predicting Postoperative Risks after Resection of Perihilar Cholangiocarcinoma. World J Surg 44, 3449–3460 (2020). https://doi.org/10.1007/s00268-020-05618-8

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