Surgery for XXXX : a multi-institutional update on practice and outcome by the AFC- @entity201 study group.

@entity1 @entity1087 @entity5 @entity887 @entity201
INTRODUCTION: Surgical resection is the only option for long-term survival in @entity1 with @entity201 ( @entity201 ), but it is associated with high morbidity and mortality. The aim of the present study was to prospectively assess the perioperative management and short-term outcomes of surgical treatment of @entity201 in a recent, multi-institutional study with a short inclusion period. METHODS: Between January and December 2008, a register prospectively collected data on @entity1 operated on for @entity201 (exploratory or curative surgery) in eight tertiary centers. The register focused on perioperative management, resectability, surgical procedures employed, morbidity, and mortality. The study cohort consisted of 56 @entity1 (40 @entity1 and 16 @entity1 ) with a median age of 63 years (range, 33-83 years). RESULTS: Among the 56 @entity1 , 47 (84%) were @entity5 were classified as Bismuth-Corlette type III-IV. Nine @entity1 (16%) underwent staging laparoscopy and four (7%) received neoadjuvant chemotherapy. Preoperative biliary drainage (endoscopy, 42%) was performed in 38 (81%) @entity1087 @entity1 and @entity887 (right side, 83%) was performed prior to surgery in 18 @entity1 (32%). Among these 56 @entity1 , curative resection was achieved in 39 (70%). All underwent major liver resection (>3 segments), bile duct resection, and lymphadenectomy. Thirteen @entity1 (36%) underwent portal vein resection, one of whom also required pancreaticoduodenectomy. Eighty-two percent of resected @entity1 (n = 32) had no proof of @entity5 prior to hepatectomy. Clear surgical margins were obtained in 77% (n = 30). The postoperative mortality was 8% and complications occurred in 72% of the resected @entity1 . Seven (25%) @entity1 required reoperation, and 15 (54%) @entity1 required percutaneous drainage. In a univariate analysis, the risk factors for morbidity were intraoperative blood transfusion (p = 0.009) and vascular clamping (p = 0.006). The median length of hospitalization was 20    13 days. CONCLUSION: Curative resection for @entity201 is associated with a high rate of R0 resection. However, surgery is associated with high levels of morbidity and mortality, despite intensive perioperative management.
