Wiggers et al developed a model for predicting mortality following resection of a perihilar cholangiocarcinoma. This can help to identify a patient who may benefit from more aggressive management. The authors are from Academic Medical Center Amsterdam, Erasmus Medical Center Rotterdam and Memorial Sloan Kettering Cancer Center.
Patient selection: resection of perihilar cholangiocarcinoma
Outcome: 90 day postoperative mortality
Parameters:
(1) age of the patient in years
(2) size of the liver remnant
(3) preoperative cholangitis
(4) portal vein reconstruction
(5) combination of biliary drainage and size of liver remnant
|
Parameter |
Finding |
Points |
|
age of the patient |
< 50 years |
0 |
|
|
50 to 59 years |
1 |
|
|
60 to 69 years |
2 |
|
|
70 to 79 years |
3 |
|
|
>= 80 years |
4 |
|
size of hepatic remnant |
>= 30% |
0 |
|
|
< 30% |
1 |
|
preoperative cholangitis |
absent |
0 |
|
|
present |
2 |
|
portal vein reconstruction |
no |
0 |
|
|
yes |
1 |
|
biliary drainage and size of hepatic remnant |
complete biliary drainage |
0 |
|
|
hepatic remnant >= 50% |
0 |
|
|
incomplete biliary drainage and remnant < 50% |
1 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the postoperative mortality.
|
Score |
Mortality |
|
0 or 1 |
1% |
|
2 |
3% |
|
3 |
6% |
|
4 |
14% |
|
5 |
28% |
|
6 |
47% |
|
7 |
67% |
|
8 |
82% |
|
9 |
NA (no patients) |
Performance:
• The area under the ROC curve was 0.75.
Specialty: Gastroenterology, Surgery, general, Surgery, orthopedic
