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Article: Defining the optimal bilirubin level before hepatectomy for hilar cholangiocarcinoma
Title | Defining the optimal bilirubin level before hepatectomy for hilar cholangiocarcinoma |
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Authors | |
Keywords | PTBD Preoperative biliary drainage Bilirubin level Hilar cholangiocarcinoma ERCP Hepatectomy |
Issue Date | 2020 |
Citation | BMC Cancer, 2020, v. 20, n. 1, article no. 914 How to Cite? |
Abstract | Background: In the management of operable hilar cholangiocarcinoma (HC) patients with hyperbilirubinemia, preoperative biliary drainage is a measure to bring down the bilirubin to a certain level so as to avoid adverse postoperative outcomes that would otherwise result from hyperbilirubinemia. A cutoff value of bilirubin level in this context is needed but has not been agreed upon without controversy. This retrospective study aimed to identify a cutoff of preoperative bilirubin level that would minimize postoperative morbidity and mortality. Methods: Data of patients having hepatectomy with curative intent for HC were analyzed. Discriminative analysis was performed to identify the preoperative bilirubin level that would make a survival difference. The identified level was used as the cutoff to divide patients into two groups. The groups were compared. Results: Ninety patients received hepatectomy with curative intent for HC. Their median preoperative bilirubin level was 23 μmol/L. A cutoff preoperative bilirubin level of 75 μmol/L was derived from Youden's index (sensitivity 0.333; specificity 0.949) and confirmed to be optimal by logistic regression (relative risk 9.250; 95% confidence interval 1.932-44.291; p = 0.005), with mortality shown to be statistically different at 90 days (p = 0.008). Patients were divided into Group A (≤75 μmol/L; n = 82) and Group B (> 75 μmol/L; n = 8). Group B had a higher preoperative bilirubin level (p < 0.001), more intraoperative blood loss (3.12 vs 1.4 L; p = 0.008), transfusion (100% vs 42.0%; p = 0.011) and replacement (2.45 vs 0.0 L; p < 0.001), more postoperative renal complications (p = 0.036), more in-hospital deaths (50% vs 8.5%; p = 0.004), and more 90-day deaths (50% vs 9.8%; p = 0.008). Group A had a longer follow-up period (p = 0.008). The groups were otherwise comparable. Disease-free survival was similar between groups (p = 0.142) but overall survival was better in Group A (5-year, 25.2% vs 0%; p < 0.001). On multivariate analysis, preoperative bilirubin level and intraoperative blood replacement were risk factors for 90-day mortality. Conclusion: A cutoff value of preoperative bilirubin level of 75 μmol/L is suggested, as the study showed that a preoperative bilirubin level ≤ 75 μmol/L resulted in significantly less blood replacement necessitated by blood loss during operation and significantly better patient survival after surgery. |
Persistent Identifier | http://hdl.handle.net/10722/295182 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | She, WH | - |
dc.contributor.author | Cheung, TT | - |
dc.contributor.author | Ma, KW | - |
dc.contributor.author | Tsang, SHY | - |
dc.contributor.author | Dai, WC | - |
dc.contributor.author | Chan, ACY | - |
dc.contributor.author | Lo, CM | - |
dc.date.accessioned | 2021-01-05T04:59:14Z | - |
dc.date.available | 2021-01-05T04:59:14Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | BMC Cancer, 2020, v. 20, n. 1, article no. 914 | - |
dc.identifier.uri | http://hdl.handle.net/10722/295182 | - |
dc.description.abstract | Background: In the management of operable hilar cholangiocarcinoma (HC) patients with hyperbilirubinemia, preoperative biliary drainage is a measure to bring down the bilirubin to a certain level so as to avoid adverse postoperative outcomes that would otherwise result from hyperbilirubinemia. A cutoff value of bilirubin level in this context is needed but has not been agreed upon without controversy. This retrospective study aimed to identify a cutoff of preoperative bilirubin level that would minimize postoperative morbidity and mortality. Methods: Data of patients having hepatectomy with curative intent for HC were analyzed. Discriminative analysis was performed to identify the preoperative bilirubin level that would make a survival difference. The identified level was used as the cutoff to divide patients into two groups. The groups were compared. Results: Ninety patients received hepatectomy with curative intent for HC. Their median preoperative bilirubin level was 23 μmol/L. A cutoff preoperative bilirubin level of 75 μmol/L was derived from Youden's index (sensitivity 0.333; specificity 0.949) and confirmed to be optimal by logistic regression (relative risk 9.250; 95% confidence interval 1.932-44.291; p = 0.005), with mortality shown to be statistically different at 90 days (p = 0.008). Patients were divided into Group A (≤75 μmol/L; n = 82) and Group B (> 75 μmol/L; n = 8). Group B had a higher preoperative bilirubin level (p < 0.001), more intraoperative blood loss (3.12 vs 1.4 L; p = 0.008), transfusion (100% vs 42.0%; p = 0.011) and replacement (2.45 vs 0.0 L; p < 0.001), more postoperative renal complications (p = 0.036), more in-hospital deaths (50% vs 8.5%; p = 0.004), and more 90-day deaths (50% vs 9.8%; p = 0.008). Group A had a longer follow-up period (p = 0.008). The groups were otherwise comparable. Disease-free survival was similar between groups (p = 0.142) but overall survival was better in Group A (5-year, 25.2% vs 0%; p < 0.001). On multivariate analysis, preoperative bilirubin level and intraoperative blood replacement were risk factors for 90-day mortality. Conclusion: A cutoff value of preoperative bilirubin level of 75 μmol/L is suggested, as the study showed that a preoperative bilirubin level ≤ 75 μmol/L resulted in significantly less blood replacement necessitated by blood loss during operation and significantly better patient survival after surgery. | - |
dc.language | eng | - |
dc.relation.ispartof | BMC Cancer | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | PTBD | - |
dc.subject | Preoperative biliary drainage | - |
dc.subject | Bilirubin level | - |
dc.subject | Hilar cholangiocarcinoma | - |
dc.subject | ERCP | - |
dc.subject | Hepatectomy | - |
dc.title | Defining the optimal bilirubin level before hepatectomy for hilar cholangiocarcinoma | - |
dc.type | Article | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1186/s12885-020-07385-0 | - |
dc.identifier.pmid | 32967634 | - |
dc.identifier.pmcid | PMC7513475 | - |
dc.identifier.scopus | eid_2-s2.0-85091550863 | - |
dc.identifier.volume | 20 | - |
dc.identifier.issue | 1 | - |
dc.identifier.spage | article no. 914 | - |
dc.identifier.epage | article no. 914 | - |
dc.identifier.eissn | 1471-2407 | - |
dc.identifier.isi | WOS:000575203800008 | - |
dc.identifier.issnl | 1471-2407 | - |