Cholangiocarcinoma: Predicting survival and complications after surgery

In Part I, survival of patients with perihilar cholangiocarcinoma (pCCA) is discussed. Chapter 2 evaluates the nationwide survival outcomes of treatment (i.e., resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e., academic, teaching, or regular hospital) of pCCA in the Netherlands. In Chapter 3, a mixture cure model was used to predict what factors precluded 10-year survival after resection of pCCA. In Chapter 4, a comparison of patient characteristics and survival outcomes between patients with localized pCCA (i.e., non-metastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy and pCCA patients who underwent R1 resection. Chapter 5 is a retrospective analysis of the success, complication, and mortality rate of initial biliary drainage in palliative patients with pCCA.

In Part II, postoperative morbidity and mortality after resection of pCCA is discussed. In Chapter 6, the aim was to preoperatively assess when the predicted survival benefit no longer outweighs the surgical risk. Two separate preoperative risk models were created to predict both 90-day mortality and long-term survival for the individual patient. In Chapter 7 the occurrence and impact of readmissions, reinterventions, and complications throughout the first year after surgery for pCCA were investigated. Chapter 8 introduces the concepts of primary and secondary liver failure after major liver resection for pCCA, with identification of risk factors for each type of liver failure. The incidence of hepatic steatosis and fibrosis and their association with postoperative liver failure and mortality were evaluated in Chapter 9.

In Part III, surgical and oncological outcomes of intrahepatic cholangiocarcinoma (iCCA) is discussed. In Chapter 10 the postoperative morbidity and mortality rate after resection of iCCA is evaluated in a systematic review and meta-analysis. Chapter 11 evaluated the nationwide survival outcomes of treatment (i.e. resection, palliative systemic chemotherapy, and best supportive care) and hospital type (i.e. academic, teaching, or regular hospital) of iCCA in the Netherlands.