Morbidity after left trisectionectomy for hepato-biliary malignancies: An analysis of the National Clinical Database of Japan
Fumihiro Terasaki
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
Search for more papers by this authorShinya 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
Search for more papers by this authorHisateru 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
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorAtsushi Nanashima
Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorShohei Komatsu
Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorHiroaki 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
Search for more papers by this authorYoshihiro Kakeji
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorYuko Kitagawa
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorMasafumi Nakamura
Project Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorItaru Endo
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorFumihiro Terasaki
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
Search for more papers by this authorShinya 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
Search for more papers by this authorHisateru 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
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorAtsushi Nanashima
Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorShohei Komatsu
Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorHiroaki 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
Search for more papers by this authorYoshihiro Kakeji
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorYuko Kitagawa
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
Search for more papers by this authorMasafumi Nakamura
Project Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorItaru Endo
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorAbstract
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.
Supporting Information
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Figure S1 |
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