Textbook outcome in liver surgery for intrahepatic cholangiocarcinoma: defining predictors of an optimal postoperative course using machine learning

Abdullah Altaf; Mujtaba Khalil; Miho Akabane; Zayed Rashid; Jun Kawashima; Shahzaib Zindani; Andrea Ruzzenente; Luca Aldrighetti; Todd W Bauer; Hugo P Marques; Guillaume Martel; Irinel Popescu; Matthew J Weiss; Minoru Kitago; George Poultsides; Shishir K Maithel; Carlo Pulitano; Feng Shen; François Cauchy; Bas G Koerkamp; Itaru Endo; Timothy M Pawlik

doi:10.1016/j.hpb.2024.12.013

Textbook outcome in liver surgery for intrahepatic cholangiocarcinoma: defining predictors of an optimal postoperative course using machine learning

HPB (Oxford). 2024 Dec 18:S1365-182X(24)02460-2. doi: 10.1016/j.hpb.2024.12.013. Online ahead of print.

Authors

Abdullah Altaf¹, Mujtaba Khalil¹, Miho Akabane¹, Zayed Rashid¹, Jun Kawashima¹, Shahzaib Zindani¹, Andrea Ruzzenente², Luca Aldrighetti³, Todd W Bauer⁴, Hugo P Marques⁵, Guillaume Martel⁶, Irinel Popescu⁷, Matthew J Weiss⁸, Minoru Kitago⁹, George Poultsides¹⁰, Shishir K Maithel¹¹, Carlo Pulitano¹², Feng Shen¹³, François Cauchy¹⁴, Bas G Koerkamp¹⁵, Itaru Endo¹⁶, Timothy M Pawlik¹⁷

Affiliations

¹ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
² Department of Surgery, University of Verona, Verona, Italy.
³ Department of Surgery, San Raffaele Hospital, Milan, Italy.
⁴ Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
⁵ Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁶ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁷ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
⁸ Department of Surgery, Northwell Health, Long Island, NY, USA.
⁹ Department of Surgery, Keio University, Tokyo, Japan.
¹⁰ Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
¹¹ Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
¹² Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
¹³ Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
¹⁴ Department of Surgery, AP-HP, Beaujon Hospital, Clichy, France.
¹⁵ Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹⁶ Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
¹⁷ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: [email protected].

PMID: 39755480
DOI: 10.1016/j.hpb.2024.12.013

Abstract

Background: We sought to define textbook outcome in liver surgery (TOLS) for intrahepatic cholangiocarcinoma (ICC) by considering the implications of perioperative outcomes on overall survival (OS).

Methods: Using a multi-institutional database, TOLS for ICC was defined by employing novel machine learning (ML) models to identify perioperative factors most strongly predictive of OS ≥ 12 months. Subsequently, clinicopathologic factors associated with achieving TOLS were investigated.

Results: A total of 1556 patients with ICC were included. The ML classification models demonstrated that the absence of post-hepatectomy liver failure, intraoperative blood loss <750 mL, absence of major infectious complications, and R0 resection were the perioperative outcomes associated with prolonged OS, thereby defining TOLS for ICC. On multivariable analysis, older age, ASA class >2, lymph node metastasis, receipt of neoadjuvant therapy, advanced T status, poor histological grade and microvascular invasion were independently associated with lower odds of achieving TOLS (all p-values<0.05). Overall, 60.2 % (n = 936) of the patients achieved TOLS, demonstrating markedly improved OS and recurrence-free survival (RFS) than individuals who did not (both p < 0.05).

Conclusion: A standardized definition of TOLS for ICC was established that may be used to evaluate hospital performance at the patient level and help optimize surgical outcomes for patients with ICC.