Volume 30, Issue 12 pp. 1304-1315
ORIGINAL ARTICLE

Morbidity after left trisectionectomy for hepato-biliary malignancies: An analysis of the National Clinical Database of Japan

Fumihiro Terasaki

Fumihiro Terasaki

Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

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Shinya Hirakawa

Shinya Hirakawa

Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan

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Hisateru Tachimori

Hisateru Tachimori

Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan

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Teiichi Sugiura

Corresponding Author

Teiichi Sugiura

Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

Correspondence

Teiichi Sugiura, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.

Email: [email protected]

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Atsushi Nanashima

Atsushi Nanashima

Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

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Shohei Komatsu

Shohei Komatsu

Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

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Hiroaki Miyata

Hiroaki Miyata

Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan

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Yoshihiro Kakeji

Yoshihiro Kakeji

Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

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Yuko Kitagawa

Yuko Kitagawa

The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

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Masafumi Nakamura

Masafumi Nakamura

Project Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan

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Itaru Endo

Itaru Endo

Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan

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First published: 26 September 2023
Citations: 3

Abstract

Background

The aim of this study was to analyze the nationwide surgical outcome of a left trisectionectomy (LT) and to identify the perioperative risk factors associated with its morbidity.

Methods

Cases of LT for hepato-biliary malignancies registered at the Japanese National Clinical Database between 2013 and 2019 were retrospectively reviewed. Statistical analyses were performed to identify the perioperative risk factors associated with a morbidity of Clavien–Dindo classification (CD) ≥III.

Results

Left trisectionectomy was performed on 473 and 238 cases of biliary and nonbiliary cancers, respectively. Morbidity of CD ≥III and V occurred in 45% and 5% of cases with biliary cancer, respectively, compared with 26% and 2% of cases with nonbiliary cancer, respectively. In multivariable analyses, biliary cancer was significantly associated with a morbidity of CD ≥III (odds ratio, 1.87; p = .018). In subgroup analyses for biliary cancer, classification of American Society of Anesthesiologists physical status (ASA-PS) 2, portal vein resection (PVR), and intraoperative blood loss ≥30 mL/kg were significantly associated with a morbidity of CD ≥III.

Conclusions

Biliary cancer induces severe morbidity after LT. The ASA-PS classification, PVR, and intraoperative blood loss indicate severe morbidity after LT for biliary cancer.

CONFLICT OF INTEREST STATEMENT

Authors declare no conflict of interest for this article.

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