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Updated: Nov 6, 2025
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma
Anne-Marleen van Keulen1, Stefan Buettner2, Marc G Besselink3
1Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
Insights
Surgery for perihilar cholangiocarcinoma (pCCA) leads to frequent complications, readmissions, and reinterventions within the first year. High-volume centers are crucial for managing these complex patients and ensuring close post-discharge follow-up.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Perihilar cholangiocarcinoma (pCCA) surgery has high morbidity and mortality.
- Post-discharge outcomes significantly impact patient recovery.
- Understanding long-term complications is vital for improving patient care.
Purpose of the Study:
- To investigate morbidity and mortality in the first year after pCCA surgery.
- To analyze the frequency and types of complications, readmissions, and reinterventions.
- To assess one-year survival rates and causes of death.
Main Methods:
- Retrospective analysis of liver resections for suspected pCCA (2000-2019).
- Inclusion of consecutive patients from two tertiary referral centers.
- Collection of all morbidity and mortality data up to one year post-surgery, including recurrences.
Main Results:
- Major morbidity rate was 61%; in-hospital and 90-day mortality were 15% and 16%, respectively.
- Among discharged patients, 46% experienced complications, leading to 43% readmissions and 52% reinterventions.
- One-year overall survival was 77%, and disease-free survival was 70%.
Conclusions:
- Complications, readmissions, and reinterventions are common in the first year post-pCCA surgery.
- Complex pCCA patients require treatment in high-expertise centers with intensive perioperative care.
- Close post-discharge follow-up is essential for managing adverse events and improving outcomes.
Background:
Surgery for perihilar cholangiocarcinoma (pCCA) is associated with high morbidity and mortality rates. The impact of surgery for pCCA may affect patients after discharge. The aim of this study was to investigate all morbidity and mortality during the first year after surgery for pCCA.
Methods:
All consecutive liver resections for suspected pCCA between 2000 and 2019 at two tertiary referral centers were included. All morbidity and mortality until one year after surgery was collected retrospectively, including readmissions and reinterventions. All recurrences within the first year were scored to calculate disease-free survival.
Results:
In 250 patients, the major morbidity rate was 61% (152/250), in-hospital mortality was 15% (37/250) and 90-day mortality was 16% (40/250). In the 213 discharged patients, 98 patients (46%) suffered 260 surgical complications. These complications required 185 readmissions in 92 patients (43%) and 400 reinterventions in 110 patients (52%), including 330 radiological (83%), 61 endoscopic (15%) and 9 surgical reinterventions (2%). One-year overall survival was 77% and one-year disease-free survival was 70%. Out of the 20 patients who died within the first year after discharge, 15 died of recurrent disease and 3 due to surgery related complications and 2 of unknown causes.
Conclusion:
Readmissions, reinterventions and complications are frequent throughout the first year after surgery for pCCA in tertiary referral hospitals. These adverse events warrants treatment of these complex patients in high expertise centers offering intensive perioperative care and close follow-up of patients after discharge.
