Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with in
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ORIGINAL ARTICLE
Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma Oliver Beetz 1 & Clara A. Weigle 1 & Sebastian Cammann 1 & Florian W. R. Vondran 1 & Kai Timrott 1 & Ulf Kulik 1 & Hüseyin Bektas 2 & Jürgen Klempnauer 1 & Moritz Kleine 1 & Felix Oldhafer 1 Received: 4 April 2020 / Accepted: 9 August 2020 # The Author(s) 2020
Abstract Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and nonsurgical 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 (≥ ClavienDindo 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. Keywords Intrahepatic cholangiocarcinoma . Resection severity index . Extended surgery . Leukocytosis
Introduction Intrahepatic cholangiocarcinoma (ICC) is a malignant disease of the intrahepatic bile ducts. Although only accounting for 10 to 20% of primary hepatic malignancies, incidence and mortality rates are continuously increasing world-wide [1]. Recent Moritz Kleine and Felix Oldhafer contributed equally to this work. * Oliver Beetz [email protected] 1
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
2
Department of General, Visceral and Oncological Surgery, Hospital Group Gesundheit Nord, Bremen, Germany
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