Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study

Stefan Buettner, Ana Wilson, Georgios Antonis Margonis, Faiz Gani, Cecilia G. Ethun, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles R. Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis HatzarasRivfka Shenoy, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Introduction: Extrahepatic biliary malignancies are often diagnosed at an advanced stage. We compared patients with unresectable perihilar cholangiocarcinoma (PHCC) and gallbladder cancer (GBC) who underwent a palliative procedure versus an aborted laparotomy. Methods: Seven hundred seventy-seven patients who underwent surgery for PHCC or GBC between 2000 and 2014 were identified. Uni- and multivariable analyses were performed to identify factors associated with outcome. Results: Utilization of preoperative imaging increased over time (CT use, 80.1 % pre-2009 vs. 90 % post-2009) (p <0.001). The proportion of the patients undergoing curative-intent resection also increased (2000–2004, 67.0 % vs. 2005–2009, 74.5 % vs. 2010–2014, 78.8 %; p = 0.001). The planned surgery was aborted in 106 (13.7 %) patients and 94 (12.1 %) had a palliative procedure. A higher incidence of postoperative complications (19.2 vs. 3.8 %, p = 0.001) including deep surgical site infections (8.3 vs. 1.1 %), bleeding (4.8 vs. 0 %), bile leak (6.0 vs. 0 %) and longer length of stay (7 vs. 4.5 days) were observed among the patients who underwent a palliative surgical procedure versus an aborted non-therapeutic, non-palliative laparotomy (all p <0.05). OS was comparable among the patients who underwent a palliative procedure (8.7 months) versus an aborted laparotomy (7.8 months) (p = 0.23). Conclusion: Increased use of advanced imaging modalities was accompanied by increased curative-intent surgery. Compared with patients in whom surgery was aborted, patients who underwent surgical palliation demonstrated an increased incidence of postoperative morbidity with comparable survival.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Apr 27 2016

    Fingerprint

Keywords

  • Biliary
  • Extrahepatic
  • Malignancy
  • Palliation
  • Surgical

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Buettner, S., Wilson, A., Margonis, G. A., Gani, F., Ethun, C. G., Poultsides, G. A., Tran, T., Idrees, K., Isom, C. A., Fields, R. C., Krasnick, B., Weber, S. M., Salem, A., Martin, R. C. G., Scoggins, C. R., Shen, P., Mogal, H. D., Schmidt, C., Beal, E., ... Pawlik, T. M. (Accepted/In press). Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study. Journal of Gastrointestinal Surgery, 1-9. https://doi.org/10.1007/s11605-016-3155-6