Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers

Matteo Mueller, Eva Breuer, Takashi Mizuno, Fabian Bartsch, Francesca Ratti, Christian Benzing, Noémie Ammar-Khodja, Teiichi Sugiura, Tsukasa Takayashiki, Amelia Hessheimer, Hyung Sun Kim, Andrea Ruzzenente, Keun Soo Ahn, Tiffany Wong, Jan Bednarsch, Mizelle D'Silva, Bas Groot Koerkamp, Heithem Jeddou, Victor López-López, Charles de PonthaudJennifer A. Yonkus, Warsan Ismail, Lynn E. Nooijen, Camila Hidalgo-Salinas, Elissaios Kontis, Kim C. Wagner, Ganesh Gunasekaran, Ryota Higuchi, Ana Gleisner, Chaya Shwaartz, Gonzalo Sapisochin, Richard D. Schulick, Masakazu Yamamoto, Takehiro Noji, Satoshi Hirano, Myron Schwartz, Karl J. Oldhafer, Andreas Prachalias, Giuseppe K. Fusai, Joris I. Erdmann, Pål Dag Line, Rory L. Smoot, Olivier Soubrane, Ricardo Robles-Campos, Karim Boudjema, Wojciech G. Polak, Ho Seong Han, Ulf P. Neumann, Chung Mau Lo, Koo Jeong Kang, Alfredo Guglielmi, Joon Seong Park, Constantino Fondevila, Masayuki Ohtsuka, Katsuhiko Uesaka, René Adam, Johann Pratschke, Luca Aldrighetti, Michelle L. De Oliveira, Gregory J. Gores, Hauke Lang, Masato Nagino, Pierre Alain Clavien*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

72 Citations (Scopus)


OBJECTIVE: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons. BACKGROUND: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking. METHODS: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers. RESULTS: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes. CONCLUSION: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.

Original languageEnglish
Pages (from-to)780-788
Number of pages9
JournalAnnals of Surgery
Issue number5
Publication statusPublished - Nov 2021

Bibliographical note

The authors convey their appreciation for the help in preparing the manuscript to Dr. Milo Puhan, University of Zurich, Dr. Antoinette Bonaccorso, Icahn School of Medicine at Mount Sinai, New York; Dr. Roberto Brusadin, Clinic and University Hospital Virgen de la Arrixaca, Murcia; Dr. François Cauchy from the Beaujon University Hospital, Clichy; Dr. Jereon de Jonge, Erasmus MC University Medical Center, Rotterdam; Dr. Stijn Franssen, Erasmus MC University Medical Center, Rotterdam; Dr. Kristoffer Lassen, Oslo University Hospital, Oslo; Dr. Trevor Nydam, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dr. James Pomposelli, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dr. Dimitri A. Raptis, Royal Free Hospital, London; Mr Parthi Srinivasan, King's College Hospital, London; Dr. Tim Reese, Asklepios Hospital Barmbek, Hamburg; Dr. Stylianos Tzedakis, CHU Rennes, Rennes; Dr. Michael Wachs, University of Colorado Anschutz Medical Campus, Aurora, Colorado and finally we thank Mrs Susanne Gaal from the University Hospital Zurich, Switzerland, for contributing to the coordination of the study.

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