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The following is a summary of “Preoperative predictors for non-resectability in perihilar cholangiocarcinoma,” published in the February 2024 issue of Surgery by Otto et al.

The occurrence of explorative laparotomy without feasible curative liver resection presents a significant challenge in the management of perihilar cholangiocarcinoma (pCCA). Thus, they aimed to identify preoperative determinants associated with non-resectability in patients diagnosed with pCCA.

Researchers analyzed patients who underwent surgical exploration between 2010 and 2022. Separate binary logistic regression analyses were employed to ascertain risk factors contributing to non-resectability following explorative laparotomy, considering technical aspects (tumor extent, vessel infiltration) and oncological factors (peritoneal carcinomatosis, distant nodal or liver metastases) and liver function.

The study cohort consisted of 318 patients, with 209 (65.7%) undergoing surgical resection and 109 (34.3%) undergoing surgical exploration. Among these, 87 (27.4%) underwent explorative laparotomy, while 22 (6.9%) underwent laparoscopic exploration. The median age of the cohort was 69 years (range 60–75), with a majority presenting significant comorbidities (202/318, 63.5%). Statistically essential risk factors (p < 0.05) for non-resectability included age over 70 years (HR = 3.76, p = 0.003), portal vein embolization (PVE, HR = 5.73, p = 0.007), and arterial infiltration > 180° (HR = 8.05 p < 0.001) for technical non-resectability, and PVE (HR = 4.67, p = 0.018), arterial infiltration > 180° (HR = 3.24, p = 0.015), and elevated CA 19–9 (HR = 3.2, p = 0.009) for oncological/liver-functional non-resectability.

Advanced age, PVE, arterial infiltration, and elevated CA19-9 are significant risk factors associated with non-resectability in pCCA patients. Preoperative assessment of these factors is pivotal for optimizing treatment strategies. Moreover, diagnostic laparoscopy, particularly in high-risk scenarios, holds the potential to minimize the number of explorative laparotomies without subsequent liver resection.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-024-03329-1