| Risk factors for postoperative complication after radical surgery of biliary malignancyObjective:To determine the factors affecting postoperative complication after radical surgery of biliary malignancy(hilar cholangiocarcinoma,gallbladder cancer and intrahepatic cholangiocarcinoma).Methods:The clinical data of 45 biliary malignancy patients undergoing radical surgical treatment between September 2013 and December 2015 were retrospectively analyzed.All patients were seen at the Department of Hepatopancreatobiliary Surgery of Nanjing Drum Tower Hospital.Uni-and multivariate logistic regression analysis was used to identify independent risk factors for major complications and infectious after surgery.Results:Of the total of 45 biliary malignancy patients included in this study,there were no cases of in-hospital mortality after surgical treatment,and 10(22%)patients developed major complication.Infectious was the most frequent complication found in 25(56%)patients,followed by bile leakage in 13(29%).Multivariate analysis identified a single independent risk factor for postoperative major complications after radical surgery,namely,total bile acid concentration in serum on postoperative day 1(OR= 1.170,95%CI= 1.028-1.331,P= 0.02).The cut-off value of serum total bile acid on postoperative day 1 was determined for postoperative major complications using the receiver operating characteristic curve analysis,and it was 6.6 ?mol/L with the sensitivity and specificity of 80%and 83%,respectively.Moreover,preoperative biliary drainage was the only independent risk factor of infectious complication in the postoperative course(OR= 5.091,95%CI= 1.319?19.649,P= 0.02).Conclusions:Serum total bile acid on postoperative day 1 was the only independent risk factor for postoperative major complications after radical surgery of biliary malignancy,and the cut-off value was 6.6 ?mol/L.While preoperative biliary drainage increases the incidence of infectious complications.Value of models in predicting morbidity after radical surgery of perihilar cholangiocarcinoma:comparison of E-PASS with POSSUMObjective:To investigate the clinical value of Estimation of Physiologic Ability and Surgical Stress(E-PASS)and Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity(POSSUM)scoring systems in predicting postoperative complications of perihilar cholangiocarcinoma patients.Methods:The clinical data of 42 perihilar cholangiocarcinoma patients who underwent radical surgical treatment from September 2010 to March 2016 were retrospectively analyzed.The same surgical team performed all operations.E-PASS and POSSUM scoring systems were used to predict postoperative complications,respectively.Results:Of the total of 42 perihilar cholangiocarcinoma patients,there was no postoperative in-hospital death.Complications were seen in 34 of 42 patients(81%).The preoperative risk score(PRS),comprehensive risk score(CRS)and predicted morbidity rates via E-PASS model(Y)of the complication group were significantly higher than the non-complication group.The predicted morbidity rates via E-PASS model(Y),PRS and CRS were significantly associated with morbidity(Spearman's rank correlation coefficient:p = 0.415,P = 0.006 for Y;p = 0.373,P = 0.015 for PRS;?=0.415,P = 0.006 for CRS).And the PRS correlated with the severity of postoperative complications(Spearman's rank correlation coefficient:p ?0.383,P = 0.012).The E-PASS model showed a higher discrimination power to predict morbidity;areas under the receiver operating characteristic curve(95%confidence intervals)were 0.805(0.660-0.950)for E-PASS and 0.684(0.511-0.856)for POSSUM.The cut-off value of CRS was determined for postoperative complications using the receiver operating characteristic curve analysis,and it was 0.334.Conclusions:In our selected patient population,E-PASS system was more suitable than POSSUM system for predicting morbidity in perihilar cholangiocarcinoma patients undergoing radical surgical treatment. |
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