Surgical Treatment And Prognostic Analysis Of Hilar Cholangiocarcinoma In The Real World

Objective:The real world study of hilar cholangiocarcinoma based on the hospital information platform system evaluates the impact of different treatment methods on the treatment effect of patients and seeks simple and effective prognostic evaluation indicators in the real world evidence,so as to obtain real world evidence about the diagnosis and treatment of hilar cholangiocarcinoma and the determination of simple and effective prognostic evaluation indicators.Methods:Based on the hospital’s medical cloud system,collect and organize data on gender,age,clinical manifestations,auxiliary examinations,diagnosis,hospitalization time,postoperative complications,treatment methods,postoperative follow-up,and follow-up of patients diagnosed with hilar cholangiocarcinoma in the Hepatobiliary Department of Inner Mongolia Medical University Affiliated Hospital from October 2015 to October 2022.Input all data into the EXCEL database and select appropriate research subjects based on the research purpose.Then,use SPSS25.0 statistical software to conduct statistical analysis on these data.Results:1.We have established an EXCEL database for patients with hilar cholangiocarcinoma,including their basic information,auxiliary examination results,treatment plans,tumor staging,tumor differentiation,auxiliary treatment,complications,and follow-up information.As of October 2022,a total of 128 patients’ complete data have been collected.2.Of the 28 patients,60(46.9%)underwent radical surgery,33(25.8%)underwent palliative surgery,and35(27.3%)underwent PTCD yellow reduction.Kaplan-Meier survival analysis showed that the survival time of patients with radical surgerywas longer than that of patients with palliative surgery,and the survival time of patients with palliative surgery was longer than that of patients with PTCD yellowing(P<0.05).However,the hospitalization time of patients with radical surgery was longer than that of patients with palliative surgery,and patients with palliative surgery were longer than those with PTCD yellowing(P<0.05).There was no prominent difference in the incidence of postoperative complicating disease among the three groups(P>0.05).2.In this group of 93 patients with hilar cholangiocarcinoma who underwent surgical treatment,univariate analysis showed that tumor diameter,whether or not combined with caudate lobectomy were related t othe rate of radical resection of hilar cholangiocarcinoma(P<0.05).Multivariate analysis showed that combined caudate lobectomy was an independent influencing factor for radical resection of hilar cholangiocarcinoma(P<0.05).The Kaplan Meier survival curve analysis results showed that there was a significant difference in overall survival between patients who underwent combined caudate lobectomy and those who retained the caudate lobe.The survival time of patients who underwent combined caudate lobectomy was better than that of those who retained the caudate lobe,and the difference was statistically significant(P<0.05)。3.Single factor analysis showed that the incidence of postoperative complicating disease in patients with Onodera prognostic nutritional index(OPNI)<41.975 was significantly higher than that in patients with OPNI≥41.975(20.8% vs 5%,P<0.05).The first postoperative exhaust time in the OPNI<41.975 group was prominently longer than that in the OPNI≥ 41.975 group(3.45 ± 0.49 days vs 3.02 ± 0.96 days,P<0.05).The overall 3-year survival period of patients with OPNI≥41.975 was significantly better than that of patients with OPNI<41.975(P<0.05).When OPNI=41.975 is taken as the threshold value,it has good consistency with the European Nutrition Risk Screening 2002(NRS 2002)(Kappa=0.700,t=7.276,P<0.001).Conclusions:1.Radical resection of hilar cholangiocarcinoma is the most effective treatment for hilar cholangiocarcinoma,followed by palliative resection,and PTCD is the first choice for patients who cannot operate.Patients who had undergone radical resection had a significantly improved survival rate compared to those who only had palliative resection or PTCD yellowing reduction.2.Combined caudate lobectomy is an independent influencing factor for radical resection of hilar cholangiocarcinoma.The patients who underwent combined caudate lobectomy had a better curative effect than those who retained the caudate lobe,and had a longer survival period,and would not increase the incidence of postoperative complications.3.The incidence of postoperative complications in those with OPNI less than41.975 was notably greater than in those with OPNI greater than 41.975,and the initial postoperative exhaustion time in those with OPNI less than 41.975 was notably longer than that of those with OPNI greater than 41.975 this is an independent factor that affects the adverse clinical outcome of patients with hilar cholangiocarcinoma post-surgery.The overall survival period of patients with OPNI≥41.975 was significantly better than that of patients with OPNI<41.975.OPNI=41.975 can be used as the diagnostic threshold for clinical and epidemiological screening and evaluation of preoperative nutritional risk of patients with hilar cholangiocarcinoma,and to judge the prognosis of patients,so as to improve the survival results of patients through early and effective intervention.