Detailed Abstract
[E-poster - Liver (Liver Disease/Surgery)]
[EP 010] Preventing Futile Surgery in Intrahepatic And Perihilar Cholangiocarcinomas: Can We Identify Preoperative Factors to Improve Patient Selection And Optimize Outcomes?
Gurudutt VARTY 1, Niket SHAH 1, Shraddha PATKAR 1, Mahesh GOEL 1
1 Department of GI & HPB Oncology, Tata Memorial Hospital, Mumbai, INDIA
Background : Intraoperative unresectability, postoperative deaths and early recurrences remain devastating futile events in the surgical management of Intrahepatic cholangiocarcinomas (IHCC) and Perihilar cholangiocarcinomas (PHCC). The present study aims to determine the preoperative predictors of futile surgery in cholangiocarcinomas
Methods : Consecutive hepatectomies for IHCC and PHCC, between September 2010 and June 2022 were included. Futility of surgery was defined as intraoperative unresectability, postoperative 30-day mortality and recurrence within six months of surgery.
Results : One hundred and fifty patients of IHCC and PHCC underwent surgery during the time period. Thirty-seven (38.1%) out of 97 patients of IHCC and 25(47.16%) out of 53 patients of PHCC underwent futile resection. The predictive factors of futile surgery for IHCC were tumour number (≥2) (OR, 9.705; 95%CI, 2.378-39.614; p=0.002), serum aspartate transaminase (OR, 8.31; 95%CI, 2.796-24.703; p<0.001) and serum CA-19.9 (>37 U/ml) (OR, 2.95; 95%CI, 1.051 – 8.283; p=0.04). The predictive factors of futility for PHCC were lymph node involvement (OR, 7.636; 95%CI, 1.824-31.979; p=0.005) and serum alkaline phosphatase (>562.5 U/L) (OR, 11.211; 95%CI, 1.752-71.750; p=0.011).
Conclusions : Futile surgery was observed in over one third of our patients. Five strong preoperative predictors of futility were identified. Careful analysis of these factors may reduce futile surgical explorations.
Methods : Consecutive hepatectomies for IHCC and PHCC, between September 2010 and June 2022 were included. Futility of surgery was defined as intraoperative unresectability, postoperative 30-day mortality and recurrence within six months of surgery.
Results : One hundred and fifty patients of IHCC and PHCC underwent surgery during the time period. Thirty-seven (38.1%) out of 97 patients of IHCC and 25(47.16%) out of 53 patients of PHCC underwent futile resection. The predictive factors of futile surgery for IHCC were tumour number (≥2) (OR, 9.705; 95%CI, 2.378-39.614; p=0.002), serum aspartate transaminase (OR, 8.31; 95%CI, 2.796-24.703; p<0.001) and serum CA-19.9 (>37 U/ml) (OR, 2.95; 95%CI, 1.051 – 8.283; p=0.04). The predictive factors of futility for PHCC were lymph node involvement (OR, 7.636; 95%CI, 1.824-31.979; p=0.005) and serum alkaline phosphatase (>562.5 U/L) (OR, 11.211; 95%CI, 1.752-71.750; p=0.011).
Conclusions : Futile surgery was observed in over one third of our patients. Five strong preoperative predictors of futility were identified. Careful analysis of these factors may reduce futile surgical explorations.
SESSION
E-poster
E-Session 03/21 ALL DAY