Disabilities in perioperative activities of daily living have been associated with overall worse outcomes in patients with cholangiocarcinoma (CCA). Furthermore, improvements in these disabilities could lead to overall better survival rates, according to a recently published study in Hepatology Research. 

The percentage of patients that suffer from CCA and from some kind of disability in activities of daily living has increased due to the rapidly aging global population. This group of patients usually has worse treatment tolerance and poor surgical outcomes. Therefore, the authors hypothesize that patients with CCA that also present disabilities in activities of daily living could have worse survival rates.

The retrospective study analyzed the records of 70 patients with CCA that underwent surgical treatment. in an effort to associate disabilities in activities of daily living with outcomes. The authors used the Barthel index to assess the perioperative and postoperative activities of daily living. The scale measures 10 categories, including items such as grooming, clothing, mobility, and toilet use, yielding a score from 0 to 100, with 100 meaning complete independence. 

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All patients included in the study had to follow up, including physical exam, tumor markers, and imaging studies, every 4 months. Recurrence was defined as the appearance of a lesion with typical CCA characteristics. 

Among the patient cohort, only 10% (7 patients) had a Barthel index score below 100. These patients had overall greater perioperative blood losses and 90-day mortality. Interestingly, a preoperative Barthel score below 100 was correlated with a higher risk of a lower postoperative score. 

Over 20 deaths occurred in the following 3-year period. The authors noted that a Barthel score below 100 was associated with lower recurrence-free survival and overall survival.

“Integration of perioperative Barthel index scores into clinical practice may improve risk assessment in patients with intrahepatic cholangiocarcinoma (ICC), and improving preoperative disability and preventing a decline in ADL following hepatic resection may lead to favorable clinical outcomes, particularly in older or vulnerable patients with ICC,” the authors concluded.


Mima K, Hayashi H, Yumoto S, et al. Disability in perioperative activities of daily living is associated with worse survival outcomes following hepatic resection in patients with intrahepatic cholangiocarcinoma. Hepatol Res. Published online October 28, 2022. doi:10.1111/hepr.13849