Jan Bednarsch1, Zoltan Czigany1, Isabella Lurje2, Iakovos Amygdalos1, Pavel Strnad3, Paul Halm1, Georg Wiltberger1, Tom F Ulmer1, Maximilian Schulze-Hagen4, Philipp Bruners4, Ulf P Neumann5, Georg Lurje6. 1. Georg Lurje, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany. 2. Georg Lurje, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Hepatology and Gastroenterology, Campus Charité Mitte | Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany. 3. Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany. 4. Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany. 5. Georg Lurje, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands. 6. Georg Lurje, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum - Charité-Universitätsmedizin Berlin, Germany. Electronic address: georg.lurje@charite.de.
Abstract
BACKGROUND: Major liver resection has evolved as the mainstay of treatment for patients with perihilar cholangiocarcinoma (pCCA). Here we assessed the suitability of preoperative future liver remnant (FLR) measurement to predict perioperative complications, since surgical morbidity and mortality are high compared to other malignancies. METHODS: Between 2011 and 2016, 91 patients with pCCA underwent surgery in curative intent at our institution. The associations of surgical complications with FLR and clinico-pathological characteristics were assessed using logistic regression analyses. Different methods of FLR assessment, the calculated-FLR (cFLR; ratio of FLR to total liver volume), standardized FLR (sFLR; ratio of FLR to liver volume estimated by body surface area) and FLR to bodyweight ratio (FLR/BW) were tested for validity. RESULTS: Multivariable analysis identified preoperative cholangitis (Exp(B) = 0.236; p = 0.030) as the single significant predictor of postoperative mortality and cFLR (Exp(B) = 0.009, p = 0.004) as the single significant predictor of major postoperative morbidity (Clavien-Dindo ≥ 3b). Based on these findings we designed a futility criterion (cFLR<40% OR preoperative cholangitis) predicting in-house mortality. CONCLUSIONS: In patients with pCCA, the preoperative FLR<40% as well as preoperative cholangitis are two risk factors to independently predict perioperative morbidity and mortality. The cFLR should be the preferred method of liver volumetry.
BACKGROUND: Major liver resection has evolved as the mainstay of treatment for patients with perihilar cholangiocarcinoma (pCCA). Here we assessed the suitability of preoperative future liver remnant (FLR) measurement to predict perioperative complications, since surgical morbidity and mortality are high compared to other malignancies. METHODS: Between 2011 and 2016, 91 patients with pCCA underwent surgery in curative intent at our institution. The associations of surgical complications with FLR and clinico-pathological characteristics were assessed using logistic regression analyses. Different methods of FLR assessment, the calculated-FLR (cFLR; ratio of FLR to total liver volume), standardized FLR (sFLR; ratio of FLR to liver volume estimated by body surface area) and FLR to bodyweight ratio (FLR/BW) were tested for validity. RESULTS: Multivariable analysis identified preoperative cholangitis (Exp(B) = 0.236; p = 0.030) as the single significant predictor of postoperative mortality and cFLR (Exp(B) = 0.009, p = 0.004) as the single significant predictor of major postoperative morbidity (Clavien-Dindo ≥ 3b). Based on these findings we designed a futility criterion (cFLR<40% OR preoperative cholangitis) predicting in-house mortality. CONCLUSIONS: In patients with pCCA, the preoperative FLR<40% as well as preoperative cholangitis are two risk factors to independently predict perioperative morbidity and mortality. The cFLR should be the preferred method of liver volumetry.
Authors: Jan Bednarsch; Zoltan Czigany; Lara Rosaline Heij; Tom Luedde; Ronald van Dam; Sven Arke Lang; Tom Florian Ulmer; Mathias Walter Hornef; Ulf Peter Neumann Journal: Sci Rep Date: 2021-02-03 Impact factor: 4.379
Authors: Sandra Pavicevic; Sophie Reichelt; Deniz Uluk; Isabella Lurje; Cornelius Engelmann; Dominik P Modest; Uwe Pelzer; Felix Krenzien; Nathanael Raschzok; Christian Benzing; Igor M Sauer; Sebastian Stintzing; Frank Tacke; Wenzel Schöning; Moritz Schmelzle; Johann Pratschke; Georg Lurje Journal: Cancers (Basel) Date: 2022-02-17 Impact factor: 6.639
Authors: Isabella Lurje; Zoltan Czigany; Sarah Eischet; Jan Bednarsch; Tom Florian Ulmer; Peter Isfort; Pavel Strnad; Christian Trautwein; Frank Tacke; Ulf Peter Neumann; Georg Lurje Journal: Hepatol Commun Date: 2022-05-26
Authors: Dong Liu; Zoltan Czigany; Lara R Heij; Stefan A W Bouwense; Ronald van Dam; Sven A Lang; Tom F Ulmer; Ulf P Neumann; Jan Bednarsch Journal: Cancers (Basel) Date: 2022-01-16 Impact factor: 6.639