ArticleJHEP reports : innovation in hepatology2025
Failure-to-rescue as a determinant of overall survival following resection for perihilar cholangiocarcinoma.
Article in JHEP reports : innovation in hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Background & Aims: Perihilar cholangiocarcinoma (pCCA) is a surgically challenging malignancy associated with a high risk of postoperative complications. However, advances in surgical techniques, perioperative care, and systemic therapy might have improved overall survival (OS) over time. This study investigated the evolving impact of failure-to-rescue (FTR) rates and oncological treatment strategies on outcomes in patients with pCCA after curative surgery. Methods: Patients undergoing curative-intent resection for pCCA at the Mayo Clinic between 2000 and 2024 were retrospectively reviewed. Clinicopathological features were compared across three surgical eras. OS and recurrence-free survival (RFS) were assessed using Kaplan-Meier analysis, with direct matching applied to account for baseline differences. Results: Among 207 resected patients, 28% were operated on between 2000 and 2010, 35.3% between 2011 and 2017, and 36.7% between 2018 and 2024. The most recent cohort had higher rates of extended hepatectomy, vascular resection, and adjuvant therapy. Although the rate of major complications increased from 36.2% to 40.8%, FTR decreased substantially, from 29.2% to 9.7% ( Conclusions: Improved OS after pCCA resection appears to be primarily driven by reduced FTR, despite greater surgical complexity. Effective perioperative management and the ability to rescue patients from major complications remain the key determinants of survival improvement. Impact and implications: While OS in pCCA has improved over recent decades, it remains a malignancy of high surgical complexity and perioperative risk. Our study identified the reduction in FTR as the key determinant of improved outcomes, driven by increased use of rescue strategies and a shift from surgical to non-operative interventions. Although adjuvant therapy became more common over time and contributed to survival gains, its benefit diminished after adjusting for early postoperative mortality. Meanwhile, the declining rate of dropouts further reflects advances in diagnostics and patient selection, emphasizing the importance of multidisciplinary, centralized care in pCCA management.
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