Hepatic vulnerability is associated with post-hepatectomy liver failure and major morbidity after curative-intent resection of perihilar cholangiocarcinoma
4 affiliations
- 1Department of Surgery and Transplantation, University Hospital Essen, Essen, Germany
- 2German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, a partnership between German Cancer Research Center (DKFZ) and University Hospital Essen, Essen, Germany
- 3Bridge Institute of Experimental Tumor Therapy (BIT) and Division of Solid Tumor Translational Oncology (DKTK), West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- 4Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
Abstract
Background: Post-hepatectomy liver failure (PHLF) remains a major determinant of morbidity after resection for perihilar cholangiocarcinoma (pCCA). We evaluated whether a composite HVS is associated with PHLF and major morbidity after resection for pCCA.
Methods: Consecutive patients undergoing curative-intent resection for pCCA between 2010 and 2024 were retrospectively analyzed. The HVS combined preoperative hyperbilirubinemia, histological fibrosis and steatosis, with one point assigned to each component. The primary endpoint was PHLF according to ISGLS criteria; the secondary endpoint was major postoperative morbidity, defined as Clavien-Dindo grade ≥ III.
Results: Among 203 patients, PHLF occurred in 59 (29.1%) and major complications in 105 patients (51.7%). PHLF increased stepwise with higher HVS category (21.0% vs. 33.8% vs. 42.4%, p = 0.033), with a significant trend across groups (p = 0.010). Major morbidity increased with higher score levels (44.0% vs. 57.7% vs. 63.6%, p = 0.071; trend p = 0.025). In multivariable analysis, HVS was independently associated with PHLF (OR 1.77, 95% CI 1.15–2.71, p = 0.009) and major morbidity (OR 1.51, 95% CI 0.99–2.27, p = 0.050). HVS showed a numerically higher AUC than its individual components in ROC analysis.
Conclusions: A simple composite HVS combining biochemical and histological liver parameters is significantly associated with PHLF and major complications after pCCA resection. Further prospective and external validation is required to determine its potential clinical utility for risk stratification and patient selection in complex hepatobiliary surgery.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12893-026-04312-1.
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BibTeX
@article{mantas2026hepatic,
title = {{Hepatic vulnerability is associated with post-hepatectomy liver failure and major morbidity after curative-intent resection of perihilar cholangiocarcinoma}},
author = {Anna Mantas and Smiths S. Lueong and Sophia Mauerer and Antonia Krumm and Dieter P. Hoyer and Sophia M. Schmitz and Daniel Heise and Tom F. Ulmer and Jens Siveke and Ulf P. Neumann and Jan Bednarsch},
journal = {BMC Surgery},
year = {2026},
month = nov,
doi = {10.1186/s12893-026-04312-1},
url = {https://doi.org/10.1186/s12893-026-04312-1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hepatic vulnerability is associated with post-hepatectomy liver failure and major morbidity after curative-intent resection of perihilar cholangiocarcinoma
AU - Anna Mantas
AU - Smiths S. Lueong
AU - Sophia Mauerer
AU - Antonia Krumm
AU - Dieter P. Hoyer
AU - Sophia M. Schmitz
AU - Daniel Heise
AU - Tom F. Ulmer
AU - Jens Siveke
AU - Ulf P. Neumann
AU - Jan Bednarsch
PY - 2026
DA - 2026/11/03
JO - BMC Surgery
DO - 10.1186/s12893-026-04312-1
UR - https://doi.org/10.1186/s12893-026-04312-1
AB - Background: Post-hepatectomy liver failure (PHLF) remains a major determinant of morbidity after resection for perihilar cholangiocarcinoma (pCCA). We evaluated whether a composite HVS is associated with PHLF and major morbidity after resection for pCCA. Methods: Consecutive patients undergoing curative-intent resection for pCCA between 2010 and 2024 were retrospectively analyzed. The HVS combined preoperative hyperbilirubinemia, histological fibrosis and steatosis, with one point assigned to each component. The primary endpoint was PHLF according to ISGLS criteria; the secondary endpoint was major postoperative morbidity, defined as Clavien-Dindo grade ≥ III. Results: Among 203 patients, PHLF occurred in 59 (29.1%) and major complications in 105 patients (51.7%). PHLF increased stepwise with higher HVS category (21.0% vs. 33.8% vs. 42.4%, p = 0.033), with a significant trend across groups (p = 0.010). Major morbidity increased with higher score levels (44.0% vs. 57.7% vs. 63.6%, p = 0.071; trend p = 0.025). In multivariable analysis, HVS was independently associated with PHLF (OR 1.77, 95% CI 1.15–2.71, p = 0.009) and major morbidity (OR 1.51, 95% CI 0.99–2.27, p = 0.050). HVS showed a numerically higher AUC than its individual components in ROC analysis. Conclusions: A simple composite HVS combining biochemical and histological liver parameters is significantly associated with PHLF and major complications after pCCA resection. Further prospective and external validation is required to determine its potential clinical utility for risk stratification and patient selection in complex hepatobiliary surgery. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12893-026-04312-1.
SN - 1471-2482
ER -