Abstract
Background
The curative treatment of perihilar cholangiocarcinomas and centrally located intrahepatic
cholangiocarcinomas often requires major hepatectomy preceded by portal vein embolization.
This strategy, however, is associated with a high rate of dropouts before operation
or failure of resection at the time of operative exploration. We aimed to identify
predictors of unresectability (dropout or failure of resection) after portal vein
embolization for centrally located cholangiocarcinoma, including perihilar cholangiocarcinomas
and intrahepatic cholangiocarcinomas.
Method
All patients undergoing portal vein embolization for a planned resection of a centrally
located cholangiocarcinoma between 2000 and 2018 in our center were evaluated retrospectively.
Predictors of unresectability were determined under intention-to-treat conditions,
based on clinical, biologic, and radiologic data collected before portal vein embolization.
Results
Eighty-eight consecutive patients scheduled for portal vein embolization before operative
exploration were included, 56 of whom (64%) underwent curative resection and 32 (36%)
of whom were not resected, including those who did not undergo exploration (n = 11) and those operated on but not resected (n = 21). The most common cause of unresectability was tumor progression (62%). A psoas
muscle index <500 mm2/m2 (P = .04), high body mass index (P = .023), and low serum albumin level (P = .007) were associated with unresectabilty on multivariate analysis. A composite
score including these variables (cutoffs determined after receiver operating characteristic
curve analysis) was proposed and achieved accurate discrimination regarding unresectability
(area under the curve = 0.82, P < .001).
Conclusion
Predictors of unresectability after portal vein embolization for centrally located
cholangiocarcinoma were identified, with sarcopenic overweight patients having a greater
risk of unresectability. This preoperative score enables a fairly accurate prediction
of unresectability in a given patient. These simple, objective, and inexpensive parameters
should be considered in all patients with centrally located cholangiocarcinoma scheduled
to undergo portal vein embolization.
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Article info
Publication history
Published online: April 24, 2020
Accepted:
March 8,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
