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 Ponthaud; Jennifer 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

doi:10.1097/SLA.0000000000005103

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 Ponthaud

Jennifer 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

Surgery

University Hospital Zürich
Nagoya University Graduate School of Medicine
University Medical Center Mainz
IRCCS Ospedale San Raffaele
Charité – Universitätsmedizin Berlin
Hôpital Paul Brousse
Shizuoka Cancer Center
Graduate School of Medicine
University of Barcelona
Yonsei University
University of Verona
Keimyung University
The University of Hong Kong
Universitätsklinikum Aachen
Seoul National University
CHU de Rennes
Hospital Clínico Universitario Virgen de la Arrixaca
Beaujon Hospital
Mayo Clinic Rochester, MN
Oslo University Hospital
University of Amsterdam
Royal Free London NHS Foundation Trust
King's College Hospital NHS Foundation Trust
Semmelweis University
Icahn School of Medicine at Mount Sinai
Tokyo Women's Medical University
University of Colorado School of Medicine
University of Toronto
Hokkaido University
Amsterdam UMC

Research output: Contribution to journal › Article › Academic › peer-review

172 Citations (Scopus)

Abstract

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 language	English
Pages (from-to)	780-788
Number of pages	9
Journal	Annals of Surgery
Volume	274
Issue number	5
DOIs	https://doi.org/10.1097/SLA.0000000000005103
Publication status	Published - Nov 2021

Bibliographical note

Acknowledgments
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.

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1097/SLA.0000000000005103

Cite this

Mueller, M., Breuer, E., Mizuno, T., Bartsch, F., Ratti, F., Benzing, C., Ammar-Khodja, N., Sugiura, T., Takayashiki, T., Hessheimer, A., Kim, H. S., Ruzzenente, A., Ahn, K. S., Wong, T., Bednarsch, J., D'Silva, M., Koerkamp, B. G., Jeddou, H., López-López, V., ... Clavien, P. A. (2021). Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers. Annals of Surgery, 274(5), 780-788. https://doi.org/10.1097/SLA.0000000000005103

@article{c7737a869d044328b6c68ef6a3073633,

title = "Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers",

abstract = "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.",

author = "Matteo Mueller and Eva Breuer and Takashi Mizuno and Fabian Bartsch and Francesca Ratti and Christian Benzing and No{\'e}mie Ammar-Khodja and Teiichi Sugiura and Tsukasa Takayashiki and Amelia Hessheimer and Kim, \{Hyung Sun\} and Andrea Ruzzenente and Ahn, \{Keun Soo\} and Tiffany Wong and Jan Bednarsch and Mizelle D'Silva and Koerkamp, \{Bas Groot\} and Heithem Jeddou and Victor L{\'o}pez-L{\'o}pez and \{de Ponthaud\}, Charles and Yonkus, \{Jennifer A.\} and Warsan Ismail and Nooijen, \{Lynn E.\} and Camila Hidalgo-Salinas and Elissaios Kontis and Wagner, \{Kim C.\} and Ganesh Gunasekaran and Ryota Higuchi and Ana Gleisner and Chaya Shwaartz and Gonzalo Sapisochin and Schulick, \{Richard D.\} and Masakazu Yamamoto and Takehiro Noji and Satoshi Hirano and Myron Schwartz and Oldhafer, \{Karl J.\} and Andreas Prachalias and Fusai, \{Giuseppe K.\} and Erdmann, \{Joris I.\} and Line, \{P{\aa}l Dag\} and Smoot, \{Rory L.\} and Olivier Soubrane and Ricardo Robles-Campos and Karim Boudjema and Polak, \{Wojciech G.\} and Han, \{Ho Seong\} and Neumann, \{Ulf P.\} and Lo, \{Chung Mau\} and Kang, \{Koo Jeong\} and Alfredo Guglielmi and Park, \{Joon Seong\} and Constantino Fondevila and Masayuki Ohtsuka and Katsuhiko Uesaka and Ren{\'e} Adam and Johann Pratschke and Luca Aldrighetti and \{De Oliveira\}, \{Michelle L.\} and Gores, \{Gregory J.\} and Hauke Lang and Masato Nagino and Clavien, \{Pierre Alain\}",

note = "Acknowledgments 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. Fran{\c c}ois 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. Publisher Copyright: Copyright {\textcopyright} 2021 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2021",

month = nov,

doi = "10.1097/SLA.0000000000005103",

language = "English",

volume = "274",

pages = "780--788",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

number = "5",

}

Mueller, M, Breuer, E, Mizuno, T, Bartsch, F, Ratti, F, Benzing, C, Ammar-Khodja, N, Sugiura, T, Takayashiki, T, Hessheimer, A, Kim, HS, Ruzzenente, A, Ahn, KS, Wong, T, Bednarsch, J, D'Silva, M, Koerkamp, BG, Jeddou, H, López-López, V, de Ponthaud, C, Yonkus, JA, Ismail, W, Nooijen, LE, Hidalgo-Salinas, C, Kontis, E, Wagner, KC, Gunasekaran, G, Higuchi, R, Gleisner, A, Shwaartz, C, Sapisochin, G, Schulick, RD, Yamamoto, M, Noji, T, Hirano, S, Schwartz, M, Oldhafer, KJ, Prachalias, A, Fusai, GK, Erdmann, JI, Line, PD, Smoot, RL, Soubrane, O, Robles-Campos, R, Boudjema, K, Polak, WG, Han, HS, Neumann, UP, Lo, CM, Kang, KJ, Guglielmi, A, Park, JS, Fondevila, C, Ohtsuka, M, Uesaka, K, Adam, R, Pratschke, J, Aldrighetti, L, De Oliveira, ML, Gores, GJ, Lang, H, Nagino, M & Clavien, PA 2021, 'Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers', Annals of Surgery, vol. 274, no. 5, pp. 780-788. https://doi.org/10.1097/SLA.0000000000005103

TY - JOUR

T1 - Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers

AU - Mueller, Matteo

AU - Breuer, Eva

AU - Mizuno, Takashi

AU - Bartsch, Fabian

AU - Ratti, Francesca

AU - Benzing, Christian

AU - Ammar-Khodja, Noémie

AU - Sugiura, Teiichi

AU - Takayashiki, Tsukasa

AU - Hessheimer, Amelia

AU - Kim, Hyung Sun

AU - Ruzzenente, Andrea

AU - Ahn, Keun Soo

AU - Wong, Tiffany

AU - Bednarsch, Jan

AU - D'Silva, Mizelle

AU - Koerkamp, Bas Groot

AU - Jeddou, Heithem

AU - López-López, Victor

AU - de Ponthaud, Charles

AU - Yonkus, Jennifer A.

AU - Ismail, Warsan

AU - Nooijen, Lynn E.

AU - Hidalgo-Salinas, Camila

AU - Kontis, Elissaios

AU - Wagner, Kim C.

AU - Gunasekaran, Ganesh

AU - Higuchi, Ryota

AU - Gleisner, Ana

AU - Shwaartz, Chaya

AU - Sapisochin, Gonzalo

AU - Schulick, Richard D.

AU - Yamamoto, Masakazu

AU - Noji, Takehiro

AU - Hirano, Satoshi

AU - Schwartz, Myron

AU - Oldhafer, Karl J.

AU - Prachalias, Andreas

AU - Fusai, Giuseppe K.

AU - Erdmann, Joris I.

AU - Line, Pål Dag

AU - Smoot, Rory L.

AU - Soubrane, Olivier

AU - Robles-Campos, Ricardo

AU - Boudjema, Karim

AU - Polak, Wojciech G.

AU - Han, Ho Seong

AU - Neumann, Ulf P.

AU - Lo, Chung Mau

AU - Kang, Koo Jeong

AU - Guglielmi, Alfredo

AU - Park, Joon Seong

AU - Fondevila, Constantino

AU - Ohtsuka, Masayuki

AU - Uesaka, Katsuhiko

AU - Adam, René

AU - Pratschke, Johann

AU - Aldrighetti, Luca

AU - De Oliveira, Michelle L.

AU - Gores, Gregory J.

AU - Lang, Hauke

AU - Nagino, Masato

AU - Clavien, Pierre Alain

N1 - Acknowledgments 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. Publisher Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85115663479

U2 - 10.1097/SLA.0000000000005103

DO - 10.1097/SLA.0000000000005103

M3 - Article

C2 - 34334638

AN - SCOPUS:85115663479

SN - 0003-4932

VL - 274

SP - 780

EP - 788

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -

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

Abstract

Bibliographical note

UN SDGs

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