Impairment of preoperative activities of daily living predicts poor prognosis after surgery for perihilar cholangiocarcinoma

PURPOSES: Perihilar cholangiocarcinoma (PHC) is a rare malignancy with rising incidence and mortality. With global population aging, more patients present with impaired activities of daily living (ADL), potentially influencing surgical outcomes. This study aimed to assess the association between preoperative Barthel Index (BI) scores, a measure of ADL, and survival outcomes after PHC surgery. METHODS: We retrospectively analyzed 88 patients who underwent PHC resection from 2005 to 2020. Preoperative ADL was evaluated using the BI (range 0-100), with scores ≤ 95 defined as impaired. Cox proportional hazards regression was used to assess the impact of ADL on survival, adjusting for confounders. RESULTS: Among the 88 patients, 29 (33%) had impaired preoperative ADL (BI ≤ 95). Multivariable analysis revealed that impaired ADL was independently associated with worse overall survival (HR: 1.90, 95% CI: 1.05-3.40, P = 0.031) and recurrence-free survival (HR: 2.35, 95% CI: 1.36-4.07, P = 0.002). CONCLUSIONS: Impaired preoperative ADL is linked to poor prognosis in PHC patients. Efforts to maintain or improve perioperative ADL may enhance long-term outcomes after surgery.