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 Hatzaras & 3 others Rivfka 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

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Palliative Care
Multicenter Studies
Neoplasms
Klatskin Tumor
Laparotomy
Gallbladder Neoplasms
Surgical Wound Infection
Incidence
Bile
Length of Stay
Hemorrhage
Morbidity
Survival

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., ... 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

Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies : A 15-Year Multicenter Study. / Buettner, Stefan; Wilson, Ana; Margonis, Georgios Antonis; Gani, Faiz; Ethun, Cecilia G.; Poultsides, George A.; Tran, Thuy; Idrees, Kamran; Isom, Chelsea A.; Fields, Ryan C.; Krasnick, Bradley; Weber, Sharon M.; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles R.; Shen, Perry; Mogal, Harveshp D.; Schmidt, Carl; Beal, Eliza; Hatzaras, Ioannis; Shenoy, Rivfka; Maithel, Shishir K.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, 27.04.2016, p. 1-9.

Research output: Contribution to journalArticle

Buettner, S, Wilson, A, Margonis, GA, Gani, F, Ethun, CG, Poultsides, GA, Tran, T, Idrees, K, Isom, CA, Fields, RC, Krasnick, B, Weber, SM, Salem, A, Martin, RCG, Scoggins, CR, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Shenoy, R, Maithel, SK & Pawlik, TM 2016, 'Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study', Journal of Gastrointestinal Surgery, pp. 1-9. https://doi.org/10.1007/s11605-016-3155-6
Buettner, Stefan ; Wilson, Ana ; Margonis, Georgios Antonis ; Gani, Faiz ; Ethun, Cecilia G. ; Poultsides, George A. ; Tran, Thuy ; Idrees, Kamran ; Isom, Chelsea A. ; Fields, Ryan C. ; Krasnick, Bradley ; Weber, Sharon M. ; Salem, Ahmed ; Martin, Robert C G ; Scoggins, Charles R. ; Shen, Perry ; Mogal, Harveshp D. ; Schmidt, Carl ; Beal, Eliza ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Maithel, Shishir K. ; Pawlik, Timothy M. / Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies : A 15-Year Multicenter Study. In: Journal of Gastrointestinal Surgery. 2016 ; pp. 1-9.
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T2 - A 15-Year Multicenter Study

AU - Buettner, Stefan

AU - Wilson, Ana

AU - Margonis, Georgios Antonis

AU - Gani, Faiz

AU - Ethun, Cecilia G.

AU - Poultsides, George A.

AU - Tran, Thuy

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Fields, Ryan C.

AU - Krasnick, Bradley

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C G

AU - Scoggins, Charles R.

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2016/4/27

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N2 - 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.

AB - 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.

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KW - Extrahepatic

KW - Malignancy

KW - Palliation

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