Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2022; 28(9): 948-960
Published online Mar 7, 2022. doi: 10.3748/wjg.v28.i9.948
Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma
Zhi-Peng Liu, Wei-Yue Chen, Yan-Qi Zhang, Yan Jiang, Jie Bai, Yu Pan, Shi-Yun Zhong, Yun-Ping Zhong, Zhi-Yu Chen, Hai-Su Dai
Zhi-Peng Liu, Yan Jiang, Jie Bai, Yu Pan, Shi-Yun Zhong, Yun-Ping Zhong, Zhi-Yu Chen, Hai-Su Dai, Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
Wei-Yue Chen, Department of Clinical Center of Oncology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
Yan-Qi Zhang, Department of Health Statistics, Third Military Medical University (Army Medical University), Chongqing 400038, China
Author contributions: Dai HS had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analyses; Liu ZP, Chen ZY, Zhang YQ, Chen WY, Bai J, and Jiang Y contributed to the study concept and design; Liu ZP, Chen ZY, Zhang YQ, Chen WY, Zhong SY, Zhong YP, and Pan Y contributed to the acquisition, analyses, or interpretation of data; Liu ZP, Dai HS, Chen ZY, and Zhang YQ drafted the manuscript; Dai HS, Chen ZY, and Zhang YQ contributed to the critical revision of the manuscript for the important intellectual content; Liu ZP, Dai HS, and Zhang YQ performed the statistical analyses; Dai HS contributed to the study supervision.
Supported by National Natural Science Foundation of China, No. 81874211; and Personalized Training of Key Support Objects for The Talent People of The Army Medical University, No. XZ-2019-505-014.
Institutional review board statement: The study was approved by the Institutional Review Board of the South-West Hospital of Chongqing, China, No. KY2021129.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at daihaisu@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Su Dai, MD, Professor, Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Road, Chongqing 400038, China. daihaisu@163.com
Received: September 1, 2021
Peer-review started: September 1, 2021
First decision: November 17, 2021
Revised: November 25, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: March 7, 2022
Processing time: 182 Days and 15.3 Hours
Abstract
BACKGROUND

Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown.

AIM

To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.

METHODS

Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS).

RESULTS

Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003; RFS: 16.0 mo vs 26.0 mo, respectively, P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, P < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.

CONCLUSION

Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.

Keywords: Hilar cholangiocarcinoma; Morbidity; Surgery; Oncology; Survival; Recurrence

Core Tip: In this study, postoperative morbidity was found to be an independent risk factor for poor overall survival and recurrence-free survival following curative resection for hilar cholangiocarcinoma. In addition, this study revealed the independent risk factors associated with increased postoperative morbidity, which could help to reduce the incidence of postoperative morbidity and improve oncological prognosis.