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Major hepatectomy for intrahepatic cholangiocarcinoma or colorectal liver metastases. Are we talking about the same story?

Alexandre Doussot David Fuks Jean-Marc Regimbeau 1, 2 Olivier Farges Antonio Sa-Cunha Francois-Rene Pruvot Rene Adam Francis Navarro Daniel Azoulay Bruno Heyd Patrick Pessaux Cyril Cosse Delphine Lignier 3, 2 Julien Barbieux Emilie Lermite Antoine Hamy Francois Mauvais 3, 2 Christophe Laurent Laurence Chiche Irchid Al Naasan Jacques Belghiti Chady Salloum Philippe Compagnon Chetana Lim Mohammed Sbai Idrissi Frederic Martin Jerome Atger Emmanuel Boleslawski Jacques Baulieux Benjamin Darnis Jean Yves Mabrut Vahan Kepenekian Julie Perinel Mustapha Adham Olivier Glehen Michel Rivoire Jean Hardwigsen Anais Palen Emilie Gregoire Yves Patrice Le Treut Jean Robert Delpero Olivier Turrini Astrid Herrero Fabrizio Panaro Ahmet Ayav Laurent Bresler Philippe Rauch Francois Guillemin Frederic Marchal Jean Gugenheim Antonio Iannelli Stephane Benoist Antoine Brouquet Marc Pocard Rea Lo Dico Brice Gayet Olivier Scatton Olivier Soubrane Jean-Christophe Vaillant Tullio Piardi Daniele Sommacale Reza Kianmanesh Michel Comy Philippe Bachellier Elie Oussoultzoglou Pietro Addeo Dimitrios Ntourakis Didier Mutter Jacques Marescaux Loic Raoux Bertrand Suc Fabrice Muscari Georges Elhomsy Maximiliano Gelli Denis Castaing Gabriella Pittau Oriana Ciacio Eric Vibert Daniel Cherqui Dominique Elias Diane Goere Fabrizio Vittadello 
Abstract : Introduction: Major hepatectomy (MH) is often needed in the curative management of intrahepatic cholangiocarcinoma (IHCC) and colorectal liver metastases (CRLM). While similar outcomes could be expected after MH for IHCC and CRLM, outcomes seem worse after MH for IHCC. A better understanding of such differences might help improving perioperative outcomes but comprehensive analysis are lacking. Methods: All patients undergoing curative intent MH for IHCC or CRLM from 2003 to 2009 were included from two dedicated multi-institutional datasets. Preoperative management and short-term outcomes after MH were first compared. Independent predictors of postoperative mortality and morbidity were identified. Results: Among 827 patients, 333 and 494 patients underwent MH for IHCC and CRLM, respectively. Preoperative portal vein embolization was more frequently performed in the CRLM group (p < 0.001). MH in the IHCC group required more extended resection (p <0.001). Postoperative mortality and severe morbidity rates were significantly higher in the IHCC group (7.2% vs. 1.2% and 29.7% vs. 11.1%, p <0.001, respectively). Main causes for mortality were postoperative liver failure and deep surgical site infection. MH for IHCC was an independent risk factor for mortality (p < 0.001) and severe morbidity (p < 0.001). After propensity score matching (212 patients in each group), the aforementioned differences regarding outcomes remained statistically significant. Conclusion: This study suggests that IHCC patients are inherently more at risk after MH as compared to CRLM patients. Considering that postoperative liver failure was the most frequent cause of death, preoperative planning might have been inadequate in the setting of IHCC while more complex/extended resections should be expected. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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Alexandre Doussot, David Fuks, Jean-Marc Regimbeau, Olivier Farges, Antonio Sa-Cunha, et al.. Major hepatectomy for intrahepatic cholangiocarcinoma or colorectal liver metastases. Are we talking about the same story?. EJSO - European Journal of Surgical Oncology, WB Saunders, 2019, 45 (12), pp.2353-2359. ⟨10.1016/j.ejso.2019.07.033⟩. ⟨hal-03595877⟩



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