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

Research output: Contribution to journal › (Systematic) Review article › peer-review

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
Volume	173
Issue number	4
Early online date	26 Dec 2022
DOIs	https://doi.org/10.1016/j.surg.2022.11.027
Publication status	Published - Apr 2023

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10.1016/j.surg.2022.11.027Licence: CC BY

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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, 173(4), 973-982. https://doi.org/10.1016/j.surg.2022.11.027

@article{d6442f15d3504160866bd31f54fc4c94,

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}",

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-ELSEVIER",

number = "4",

}

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.

U2 - 10.1016/j.surg.2022.11.027

DO - 10.1016/j.surg.2022.11.027

M3 - (Systematic) Review article

C2 - 36577599

SN - 0039-6060

VL - 173

SP - 973

EP - 982

JO - Surgery

JF - Surgery

IS - 4

ER -