Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis

Anne Marleen van Keulen; Stefan Büttner; Joris I. Erdmann; Jeroen Hagendoorn; Frederik J.H. Hoogwater; Jan N.M. IJzermans; Ulf P. Neumann; Wojciech G. Polak; Jeroen De Jonge; Pim B. Olthof; Bas Groot Koerkamp

doi:10.1016/j.surg.2022.11.027

Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis

Anne Marleen van Keulen, Stefan Büttner, Joris I. Erdmann, Jeroen Hagendoorn, Frederik J.H. Hoogwater, Jan N.M. IJzermans, Ulf P. Neumann, Wojciech G. Polak, Jeroen De Jonge, Pim B. Olthof, Bas Groot Koerkamp^*

^*Corresponding author for this work

Surgery

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Abstract

Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma.

Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III).

Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44).

Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection.

Original language	English
Pages (from-to)	973-982
Number of pages	10
Journal	Surgery (United States)
Volume	173
Issue number	4
Early online date	27 Dec 2022
DOIs	https://doi.org/10.1016/j.surg.2022.11.027
Publication status	Published - Apr 2023

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van Keulen, A. M., Büttner, S., Erdmann, J. I., Hagendoorn, J., Hoogwater, F. J. H., IJzermans, J. N. M., Neumann, U. P., Polak, W. G., De Jonge, J., Olthof, P. B., & Koerkamp, B. G. (2023). Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis. Surgery (United States), 173(4), 973-982. https://doi.org/10.1016/j.surg.2022.11.027

@article{2f6c2f08b49140979c7bfcd165ae5ac8,

title = "Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis",

abstract = "Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma. Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III). Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44). Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection.",

author = "{van Keulen}, {Anne Marleen} and Stefan B{\"u}ttner and Erdmann, {Joris I.} and Jeroen Hagendoorn and Hoogwater, {Frederik J.H.} and IJzermans, {Jan N.M.} and Neumann, {Ulf P.} and Polak, {Wojciech G.} and {De Jonge}, Jeroen and Olthof, {Pim B.} and Koerkamp, {Bas Groot}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2023",

month = apr,

doi = "10.1016/j.surg.2022.11.027",

language = "English",

volume = "173",

pages = "973--982",

journal = "Surgery",

issn = "0039-6060",

publisher = "Mosby Inc.",

number = "4",

}

van Keulen, AM , Büttner, S, Erdmann, JI, Hagendoorn, J, Hoogwater, FJH, IJzermans, JNM, Neumann, UP, Polak, WG , De Jonge, J , Olthof, PB & Koerkamp, BG 2023, 'Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis', Surgery (United States), vol. 173, no. 4, pp. 973-982. https://doi.org/10.1016/j.surg.2022.11.027

TY - JOUR

T1 - Major complications and mortality after resection of intrahepatic cholangiocarcinoma

T2 - A systematic review and meta-analysis

AU - van Keulen, Anne Marleen

AU - Büttner, Stefan

AU - Erdmann, Joris I.

AU - Hagendoorn, Jeroen

AU - Hoogwater, Frederik J.H.

AU - IJzermans, Jan N.M.

AU - Neumann, Ulf P.

AU - Polak, Wojciech G.

AU - De Jonge, Jeroen

AU - Olthof, Pim B.

AU - Koerkamp, Bas Groot

PY - 2023/4

Y1 - 2023/4

N2 - Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma. Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III). Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44). Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection.

AB - Background: Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma. Methods: Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III). Results: A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1–8.4); 4.6% (95% confidence interval 4.0–5.2); and 6.1% (95% confidence interval 5.0–7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7–27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8–5.2) for a minor resection, 7.4% (95% confidence interval 5.9–9.3) for all major resections, and 11.4% (95% confidence interval 6.9–18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5–49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0–24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3–5.9) compared to 6.8% (95% confidence interval 5.6–8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8–7.3) compared to 6.8% (95% confidence interval 5.1–9.1) after 2000 (P = .44). Conclusion: When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection.

UR - http://www.scopus.com/inward/record.url?scp=85144973833&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2022.11.027

DO - 10.1016/j.surg.2022.11.027

M3 - Review article

C2 - 36577599

AN - SCOPUS:85144973833

SN - 0039-6060

VL - 173

SP - 973

EP - 982

JO - Surgery

JF - Surgery

IS - 4

ER -

Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis

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