{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:35:04Z","timestamp":1791974104429,"version":"4.4.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The risk of death after surgery for perihilar cholangiocarcinoma is high; nearly one in every five patients dies within 90 days after surgery. When the oncological benefit is limited, a high-risk resection may not be justified. This retrospective cohort study aimed to create two preoperative prognostic models to predict 90-day mortality and overall survival (OS) after major liver resection for perihilar cholangiocarcinoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Separate models were built with factors known before surgery using multivariable regression analysis for 90-day mortality and OS. Patients were categorized in three groups: favourable profile for surgical resection (90-day mortality rate below 10 per cent and predicted OS more than 3 years), unfavourable profile (90-day mortality rate above 25 per cent and\/or predicted OS below 1.5 years), and an intermediate group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1673 patients were included. Independent risk factors for both 90-day mortality and OS included ASA grade III\u2013IV, large tumour diameter, and right-sided hepatectomy. Additional risk factors for 90-day mortality were advanced age and preoperative cholangitis; those for long-term OS were high BMI, preoperative jaundice, Bismuth IV, and hepatic artery involvement. In total, 294 patients (17.6 per cent) had a favourable risk profile for surgery (90-day mortality rate 5.8 per cent and median OS 42 months), 271 patients (16.2 per cent) an unfavourable risk profile (90-day mortality rate 26.8 per cent and median OS 16 months), and 1108 patients (66.2 per cent) an intermediate risk profile (90-day mortality rate 12.5 per cent and median OS 27 months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Preoperative risk models for 90-day mortality and OS can help identify patients with resectable perihilar cholangiocarcinoma who are unlikely to benefit from surgical resection. Tailored shared decision-making is particularly essential for the large intermediate group.<\/jats:p><\/jats:sec>","DOI":"10.1093\/bjs\/znad057","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T04:45:58Z","timestamp":1678855558000},"page":"599-605","source":"Crossref","is-referenced-by-count":45,"title":["Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk?"],"prefix":"10.1093","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8867-483X","authenticated-orcid":false,"given":"Anne-Marleen","family":"van Keulen","sequence":"first","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-127X","authenticated-orcid":false,"given":"Stefan","family":"Buettner","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8233-1505","authenticated-orcid":false,"given":"Joris I","family":"Erdmann","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Pratschke","sequence":"additional","affiliation":[{"name":"Department of Surgery, Campus Charit\u00e9 Mitte, Campus Virchow-Klinikum-Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-9064","authenticated-orcid":false,"given":"Francesca","family":"Ratti","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital , Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Jarnagin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas A","family":"Schnitzbauer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt , Frankfurt , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hauke","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz , Mainz , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6911-563X","authenticated-orcid":false,"given":"Andrea","family":"Ruzzenente","sequence":"additional","affiliation":[{"name":"Department of Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School , Verona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, University Hospital T\u00fcbingen , T\u00fcbingen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cescon","sequence":"additional","affiliation":[{"name":"General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baki","family":"Topal","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, University Hospitals KU Leuven , Leuven , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pim B","family":"Olthof","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute , Rotterdam , the Netherlands"},{"name":"Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1917-6973","authenticated-orcid":false,"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"2023063011002343600_znad057-B1","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/01.sla.0000251366.62632.d3","article-title":"Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution","volume":"245","author":"DeOliveira","year":"2007","journal-title":"Ann Surg"},{"issue":"Suppl 1","key":"2023063011002343600_znad057-B2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/liv.14095","article-title":"Cholangiocarcinoma: epidemiology and risk factors","volume":"39","author":"Khan","year":"2019","journal-title":"Liver Int"},{"key":"2023063011002343600_znad057-B3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3322\/caac.21208","article-title":"Cancer statistics, 2014","volume":"64","author":"Siegel","year":"2014","journal-title":"CA Cancer J Clin"},{"key":"2023063011002343600_znad057-B4","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/BF00316984","article-title":"Surgical treatment of cholangiocellular carcinoma","volume":"19","author":"Pichlmayr","year":"1995","journal-title":"World J Surg"},{"key":"2023063011002343600_znad057-B5","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.suc.2015.12.008","article-title":"Resection of perihilar cholangiocarcinoma","volume":"96","author":"Hartog","year":"2016","journal-title":"Surg Clin North Am"},{"key":"2023063011002343600_znad057-B6","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.surg.2019.01.010","article-title":"Morbidity and mortality after major liver resection in patients with perihilar cholangiocarcinoma: a systematic review and meta-analysis","volume":"165","author":"Franken","year":"2019","journal-title":"Surgery"},{"key":"2023063011002343600_znad057-B7","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.surg.2021.04.013","article-title":"Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma","volume":"170","author":"van Keulen","year":"2021","journal-title":"Surgery"},{"key":"2023063011002343600_znad057-B8","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s00268-016-3691-y","article-title":"Defining the chance of statistical cure among patients with extrahepatic biliary tract cancer","volume":"41","author":"Spolverato","year":"2017","journal-title":"World J Surg"},{"key":"2023063011002343600_znad057-B9","doi-asserted-by":"crossref","first-page":"6260","DOI":"10.3390\/cancers13246260","article-title":"Perihilar Cholangiocarcinoma Collaboration Group. Actual 10-year survival after resection of perihilar cholangiocarcinoma: what factors preclude a chance for cure?","volume":"13","author":"van Keulen","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2023063011002343600_znad057-B10","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.jamcollsurg.2015.09.005","article-title":"Recurrence rate and pattern of perihilar cholangiocarcinoma after curative intent resection","volume":"221","author":"Koerkamp","year":"2015","journal-title":"J Am Coll Surg"},{"key":"2023063011002343600_znad057-B11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jamcollsurg.2016.03.035","article-title":"Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant","volume":"223","author":"Wiggers","year":"2016","journal-title":"J Am Coll Surg"},{"key":"2023063011002343600_znad057-B12","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1093\/annonc\/mdv279","article-title":"Survival after resection of perihilar cholangiocarcinoma\u2014development and external validation of a prognostic nomogram","volume":"26","author":"Koerkamp","year":"2015","journal-title":"Ann Oncol"},{"key":"2023063011002343600_znad057-B13","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1002\/jso.25174","article-title":"A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma","volume":"118","author":"Gaspersz","year":"2018","journal-title":"J Surg Oncol"},{"key":"2023063011002343600_znad057-B14","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S2468-1253(18)30234-6","article-title":"Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial","volume":"3","author":"Coelen","year":"2018","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2023063011002343600_znad057-B15","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jclinepi.2014.11.010","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"68","author":"Collins","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"2023063011002343600_znad057-B16","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jamcollsurg.2017.06.007","article-title":"Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization","volume":"225","author":"Olthof","year":"2017","journal-title":"J Am Coll Surg"},{"key":"2023063011002343600_znad057-B17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1001\/archsurg.2011.771","article-title":"Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients","volume":"147","author":"Nuzzo","year":"2012","journal-title":"Arch Surg"},{"key":"2023063011002343600_znad057-B18","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/01.sla.0000201482.11876.14","article-title":"Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up","volume":"243","author":"Nagino","year":"2006","journal-title":"Ann Surg"},{"key":"2023063011002343600_znad057-B19","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1007\/s00268-016-3441-1","article-title":"The predictive value of indocyanine green clearance in future liver remnant for posthepatectomy liver failure following hepatectomy with extrahepatic bile duct resection","volume":"40","author":"Yokoyama","year":"2016","journal-title":"World J Surg"},{"key":"2023063011002343600_znad057-B20","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/bjs5.50273","article-title":"Effect of structured use of preoperative portal vein embolization on outcomes after liver resection of perihilar cholangiocarcinoma","volume":"4","author":"Franken","year":"2020","journal-title":"BJS Open"},{"key":"2023063011002343600_znad057-B21","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s00423-014-1210-x","article-title":"Curative-intent surgery for hilar cholangiocarcinoma: prognostic factors for clinical decision making","volume":"399","author":"Popescu","year":"2014","journal-title":"Langenbecks Arch Surg"},{"key":"2023063011002343600_znad057-B22","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1056\/NEJMoa0908721","article-title":"Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer","volume":"362","author":"Valle","year":"2010","journal-title":"N Engl J Med"},{"key":"2023063011002343600_znad057-B23","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4240\/wjgs.v11.i6.279","article-title":"Neoadjuvant therapy in the treatment of hilar cholangiocarcinoma: review of the literature","volume":"11","author":"Frosio","year":"2019","journal-title":"World J Gastrointest Surg"},{"key":"2023063011002343600_znad057-B24","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1200\/jco.2015.33.3_suppl.402","article-title":"Neoadjuvant chemoradiation therapy for cholangiocarcinoma to improve R0 resection rate: the first report of phase II study","volume":"33","author":"Yu","year":"2015","journal-title":"J Clin Oncol"},{"key":"2023063011002343600_znad057-B25","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/S1470-2045(18)30915-X","article-title":"Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study","volume":"20","author":"Primrose","year":"2019","journal-title":"Lancet Oncol"},{"key":"2023063011002343600_znad057-B26","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1002\/bjs.10776","article-title":"Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer","volume":"105","author":"Ebata","year":"2018","journal-title":"Br J Surg"},{"key":"2023063011002343600_znad057-B27","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1200\/JCO.18.00050","article-title":"Gemcitabine and oxaliplatin chemotherapy or surveillance in resected biliary tract cancer (PRODIGE 12-ACCORD 18-UNICANCER GI): a randomized phase III study","volume":"37","author":"Edeline","year":"2019","journal-title":"J Clin Oncol"},{"key":"2023063011002343600_znad057-B28","doi-asserted-by":"crossref","first-page":"4587","DOI":"10.1007\/s00520-021-06725-5","article-title":"Shared decision-making and the lessons learned about decision regret in cancer patients","volume":"30","author":"Chichua","year":"2022","journal-title":"Support Care Cancer"},{"key":"2023063011002343600_znad057-B29","first-page":"170","article-title":"Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver","volume":"140","author":"Bismuth","year":"1975","journal-title":"Surg Gynecol Obstet"},{"key":"2023063011002343600_znad057-B30","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/00000658-200110000-00010","article-title":"Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma","volume":"234","author":"Jarnagin","year":"2001","journal-title":"Ann Surg"},{"key":"2023063011002343600_znad057-B31","volume-title":"AJCC Cancer Staging Manual","author":"Edge","year":"2010","edition":"7th edn"},{"key":"2023063011002343600_znad057-B32","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1186\/s12885-020-07501-0","article-title":"Development and external validation of a nomogram for predicting the effect of tumor size on survival of patients with perihilar cholangiocarcinoma","volume":"20","author":"Zhang","year":"2020","journal-title":"BMC Cancer"},{"key":"2023063011002343600_znad057-B33","doi-asserted-by":"crossref","first-page":"37319","DOI":"10.18632\/oncotarget.9104","article-title":"Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma","volume":"7","author":"Chen","year":"2016","journal-title":"Oncotarget"},{"key":"2023063011002343600_znad057-B34","doi-asserted-by":"crossref","first-page":"54","DOI":"10.21037\/atm-20-3130","article-title":"A novel prognostic nomogram for patients with surgically resected perihilar cholangiocarcinoma: a SEER-based study","volume":"9","author":"Li","year":"2021","journal-title":"Ann Transl Med"},{"key":"2023063011002343600_znad057-B35","doi-asserted-by":"crossref","first-page":"e8570","DOI":"10.7717\/peerj.8570","article-title":"Nomograms predict survival outcome of Klatskin tumors patients","volume":"8","author":"Qi","year":"2020","journal-title":"PeerJ"},{"key":"2023063011002343600_znad057-B36","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.cgh.2020.05.035","article-title":"An unsuccessful randomized trial of percutaneous vs endoscopic drainage of suspected malignant hilar obstruction","volume":"19","author":"Elmunzer","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023063011002343600_znad057-B37","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jamcollsurg.2005.07.011","article-title":"Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma","volume":"201","author":"Corvera","year":"2005","journal-title":"J Am Coll Surg"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/110\/5\/599\/50749937\/znad057.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/110\/5\/599\/50749937\/znad057.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T23:35:27Z","timestamp":1701905727000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/110\/5\/599\/7077832"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3,15]]},"published-print":{"date-parts":[[2023,4,12]]}},"URL":"https:\/\/doi.org\/10.1093\/bjs\/znad057","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,1]]},"published":{"date-parts":[[2023,3,15]]}}}