The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma

Annals of Surgical Oncology, vol. 31, pp. 133–141

Abstract

BACKGROUND: Surgical resection for perihilar cholangiocarcinoma (pCCA) is associated with high operative risks. Impaired liver regeneration in patients with pre-existing liver disease may contribute to posthepatectomy liver failure (PHLF) and postoperative mortality. This study aimed to determine the incidence of hepatic steatosis and fibrosis and their association with PHLF and 90-day postoperative mortality in pCCA patients. METHODS: Patients who underwent a major liver resection for pCCA were included in the study between 2000 and 2021 from three tertiary referral hospitals. Histopathologic assessment of hepatic steatosis and fibrosis was performed. The primary outcomes were PHLF and 90-day mortality. RESULTS: Of the 401 included patients, steatosis was absent in 334 patients (83.3%), mild in 58 patients (14.5%) and moderate to severe in 9 patients (2.2%). There was no fibrosis in 92 patients (23.1%), periportal fibrosis in 150 patients (37.6%), septal fibrosis in 123 patients (30.8%), and biliary cirrhosis in 34 patients (8.5%). Steatosis (≥ 5%) was not associated with PHLF (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.69-2.68) or 90-day mortality (OR 1.22; 95% CI 0.62-2.39). Neither was fibrosis (i.e., periportal, septal, or biliary cirrhosis) associated with PHLF (OR 0.76; 95% CI 0.41-1.41) or 90-day mortality (OR 0.60; 95% CI 0.33-1.06). The independent risk factors for PHLF were preoperative cholangitis (OR 2.38; 95% CI 1. 36-4.17) and future liver remnant smaller than 40% (OR 2.40; 95% CI 1.31-4.38). The independent risk factors for 90-day mortality were age of 65 years or older (OR 2.40; 95% CI 1.36-4.23) and preoperative cholangitis (OR 2.25; 95% CI 1.30-3.87). CONCLUSION: In this study, no association could be demonstrated between hepatic steatosis or fibrosis and postoperative outcomes after resection of pCCA.

Authors 14

1. Anne‐Marleen van Keulen corresponding

   Erasmus MC Cancer Institute

   Affiliation as printed

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. a.m.vankeulen@erasmusmc.nl

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

2. Pim B. Olthof

   Erasmus MC Cancer Institute

   Affiliation as printed

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

3. Stefan Buettner

   Erasmus MC Cancer Institute

   Affiliation as printed

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

4. Jan Bednarsch Aachen Department of Surgery and Transplantation

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany

5. Joanne Verheij

   Amsterdam University Medical Centers · Cancer Center Amsterdam

   Affiliation as printed

   Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands

6. Joris I. Erdmann

   Amsterdam University Medical Centers · Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands

7. Lynn E. Nooijen

   Amsterdam University Medical Centers · Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands

8. Robert Jack Porte

   Erasmus MC Cancer Institute

   Affiliation as printed

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

9. Robert C. Minnee

   Erasmus MC Cancer Institute

   Affiliation as printed

   Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

10. Sarwa Darwish Murad

    Erasmus MC

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

11. Ulf P. Neumann Aachen Department of Surgery and Transplantation

    RWTH Aachen University · Universitätsklinikum Aachen · Maastricht University · Maastricht University Medical Centre

    Affiliation as printed

    Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany

    Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands

12. Lara Rosaline Heij Aachen Department of Surgery and Transplantation

    RWTH Aachen University · Universitätsklinikum Aachen · Maastricht University · Erasmus MC · Maastricht University Medical Centre

    Affiliation as printed

    Department of Pathology, Erasmus MC, Rotterdam, The Netherlands

    Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany

    Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands

13. Bas Groot Koerkamp

    Erasmus MC Cancer Institute

    Affiliation as printed

    Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

14. Michail Doukas corresponding

    Maastricht University · Maastricht University Medical Centre

    Affiliation as printed

    Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands. m.doukas@erasmusmc.nl

    Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands