PAST Failure to rescue (FTR) is increasingly used to evaluate the quality of postoperative care. Surgery for perihilar cholangiocarcinoma (pCCA) carries one of the highest risks among all elective cancer procedures, with the morbidity rate reaching 45–93% and the mortality rate reaching 6–18%.1 Whereas the predictors of morbidity and mortality after pCCA surgery are well-known, the relevance of FTR and its predictors in pCCA surgery are less defned. PRESENT In a large multicenter cohort of 2186 patients across 27 centers, the FTR rate was 24%,2 which is higher than for other major abdominal cancer surgeries.3 Age, American Society of Anesthesiologists (ASA) score, jaundice at presentation, right-side liver resections, and an annual hospital volume below six were identifed as predictors of FTR. Postoperative liver failure dominated the risk of FTR in an alternative model. FUTURE The huge impact of postoperative liver failure on FTR emphasizes the need for proper patient selection and preoperative optimization to prevent primary liver failure, which has a mortality rate of about 70%.4 Close postoperative monitoring and rapid diagnostics to detect and treat complications seem essential to prevent secondary liver failure.4 Such a strategy has been shown to decrease mortality after pancreatic surgery, and future studies should confrm its efcacy in high-risk liver surgery.5 Finally, the association of hospital volume with FTR illustrates that it might help to concentrate this rare and complex form of cancer surgery to the highest-volume hepato-pancreato-biliary centers. Even before surgery, outcomes can be detrimental, with a 40% mortality rate after the initial biliary drainage attempt and a median overall survival of only 5 months in a nationwide all-inclusive cohort after diagnosis. The multi-disciplinary experience and expertise in expert centers is likely to have a positive impact on postoperative outcomes.
Olthof, P.B., Bouwense, S.A.W., Dewulf, M., Olde Damink, S.W.M., Neumann, U.P., Koerkamp, B.G., et al. (2024). ASO Author Reflections: Liver Failure Dominates the Risk of Failure to Rescue After Surgery for Perihilar Cholangiocarcinoma. ANNALS OF SURGICAL ONCOLOGY, 32, 1825-1826 [10.1245/s10434-024-16473-5].
ASO Author Reflections: Liver Failure Dominates the Risk of Failure to Rescue After Surgery for Perihilar Cholangiocarcinoma
Troisi R. I.;Serenari M.;Ravaioli M.;Ratti F.;Prasad R.;Lang H.;Cescon M.;
2024
Abstract
PAST Failure to rescue (FTR) is increasingly used to evaluate the quality of postoperative care. Surgery for perihilar cholangiocarcinoma (pCCA) carries one of the highest risks among all elective cancer procedures, with the morbidity rate reaching 45–93% and the mortality rate reaching 6–18%.1 Whereas the predictors of morbidity and mortality after pCCA surgery are well-known, the relevance of FTR and its predictors in pCCA surgery are less defned. PRESENT In a large multicenter cohort of 2186 patients across 27 centers, the FTR rate was 24%,2 which is higher than for other major abdominal cancer surgeries.3 Age, American Society of Anesthesiologists (ASA) score, jaundice at presentation, right-side liver resections, and an annual hospital volume below six were identifed as predictors of FTR. Postoperative liver failure dominated the risk of FTR in an alternative model. FUTURE The huge impact of postoperative liver failure on FTR emphasizes the need for proper patient selection and preoperative optimization to prevent primary liver failure, which has a mortality rate of about 70%.4 Close postoperative monitoring and rapid diagnostics to detect and treat complications seem essential to prevent secondary liver failure.4 Such a strategy has been shown to decrease mortality after pancreatic surgery, and future studies should confrm its efcacy in high-risk liver surgery.5 Finally, the association of hospital volume with FTR illustrates that it might help to concentrate this rare and complex form of cancer surgery to the highest-volume hepato-pancreato-biliary centers. Even before surgery, outcomes can be detrimental, with a 40% mortality rate after the initial biliary drainage attempt and a median overall survival of only 5 months in a nationwide all-inclusive cohort after diagnosis. The multi-disciplinary experience and expertise in expert centers is likely to have a positive impact on postoperative outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
