Older age and high carbohydrate antigen 19-9 levels are risk factors for failure to rescue following right-sided hepatectomy to treat perihilar cholangiocarcinoma, according to a new study published in Surgery.

First author Christian Benzing, MD, and the coauthors of the study wrote that patients should therefore be assessed critically before the operation to determine whether it can be performed safely. Patients should also be closely monitored after surgery to immediately detect and treat potentially life-threatening complications, especially if they are at high risk.

To identify independent risk factors leading to failure to rescue following hepatectomy for perihilar cholangiocarcinoma, a team of researchers led by Johann Pratschke, MD, from the Department of Surgery at Charité – Universitätsmedizin Berlin in Germany conducted a retrospective, single-center cohort study to analyze the postoperative course of 287 patients who underwent major hepatectomy to treat perihilar cholangiocarcinoma between 2005 and 2019.


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The results showed that 186 out of 287 patients (65%) had major complications following surgery. Of the 186, failure to rescue occurred in 44 patients (24%). 

Read more about cholangiocarcinoma prognosis

Age >65 years and right-sided resection were independent factors associated with failure to rescue. Moreover, carbohydrate antigen 19-9 levels >100 kU/mL and chemotherapy before the operation seemed to increase the risk of failure to rescue according to the authors, although this was not statistically significant.

Perihilar cholangiocarcinoma is the most common subtype of cholangiocarcinoma. It has a poor prognosis, and the 5-year survival rate remains between 10% and 35%, even after curative resection. 

Failure to rescue is defined as the failure to prevent death due to a complication from surgery. The management of complications following hepatectomy for perihilar cholangiocarcinoma is not always successful and may lead to failure to rescue.

Reference

Benzing C, Schmelzle M, Atik CF, et al. Factors associated with failure to rescue after major hepatectomy for perihilar cholangiocarcinoma: a 15-year single-center experience. Surgery. Published online February 2, 2022. doi:10.1016/j.surg.2021.08.057