Abstract
Background: Cholangiocarcinomas are deadly and require complex decisions as well as major surgery. A few referral centers have reported good results, but no robust, risk-adjusted outcomes data are available. The aims of this study were to analyze the surgical outcomes of a very large cohort of patients undergoing operations for cholangiocarcinoma in North America. Study Design: The American College of Surgeons National Surgical Quality Improvement Program Participant Use File was queried for patients with bile duct cancers. Patients (n = 839) were classified as having intrahepatic (36.5%), perihilar (34.4%), or distal (29.1%) cholangiocarcinomas by the type of procedure performed. Observed and expected (O/E) morbidity and mortality rates, O/E indices, and regression-adjusted risk factors were determined. Results: Mortality was highest for perihilar tumors that were managed with hepatectomy and biliary-enteric anastomosis (11.9%) and lowest for distal cholangiocarcinomas (1.2%). After risk adjustment, mortality was considerable greater than expected for patients undergoing hepatectomy with biliary-enteric anastomosis (O/E = 3.0) or hepatectomy alone (O/E = 2.4). Conclusions: This analysis suggests that postoperative outcomes are best for distal and worst for perihilar cholangiocarcinomas, and hepatectomy for bile duct cancers is associated with a 2- to 3-fold mortality risk. We conclude that North American surgical outcomes can be improved for patients with proximal cholangiocarcinomas.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 192-200 |
| Number of pages | 9 |
| Journal | Journal of the American College of Surgeons |
| Volume | 216 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2013 |
| Externally published | Yes |
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Keywords
- ACS
- American College of Surgeons
- BEA
- biliary-enteric anastomosis
- interquartile range
- IQR
- National Surgical Quality Improvement Program
- NSQIP
- O/E
- observed/expected
- Participant Use File
- PUF
ASJC Scopus subject areas
- Surgery
Cite this
Cholangiocarcinoma : Are north american surgical outcomes optimal? / Loehrer, Andrew P.; House, Michael G.; Nakeeb, Attila; Kilbane, E. Molly; Pitt, Henry A.
In: Journal of the American College of Surgeons, Vol. 216, No. 2, 02.2013, p. 192-200.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cholangiocarcinoma
T2 - Are north american surgical outcomes optimal?
AU - Loehrer, Andrew P.
AU - House, Michael G.
AU - Nakeeb, Attila
AU - Kilbane, E. Molly
AU - Pitt, Henry A.
PY - 2013/2
Y1 - 2013/2
N2 - Background: Cholangiocarcinomas are deadly and require complex decisions as well as major surgery. A few referral centers have reported good results, but no robust, risk-adjusted outcomes data are available. The aims of this study were to analyze the surgical outcomes of a very large cohort of patients undergoing operations for cholangiocarcinoma in North America. Study Design: The American College of Surgeons National Surgical Quality Improvement Program Participant Use File was queried for patients with bile duct cancers. Patients (n = 839) were classified as having intrahepatic (36.5%), perihilar (34.4%), or distal (29.1%) cholangiocarcinomas by the type of procedure performed. Observed and expected (O/E) morbidity and mortality rates, O/E indices, and regression-adjusted risk factors were determined. Results: Mortality was highest for perihilar tumors that were managed with hepatectomy and biliary-enteric anastomosis (11.9%) and lowest for distal cholangiocarcinomas (1.2%). After risk adjustment, mortality was considerable greater than expected for patients undergoing hepatectomy with biliary-enteric anastomosis (O/E = 3.0) or hepatectomy alone (O/E = 2.4). Conclusions: This analysis suggests that postoperative outcomes are best for distal and worst for perihilar cholangiocarcinomas, and hepatectomy for bile duct cancers is associated with a 2- to 3-fold mortality risk. We conclude that North American surgical outcomes can be improved for patients with proximal cholangiocarcinomas.
AB - Background: Cholangiocarcinomas are deadly and require complex decisions as well as major surgery. A few referral centers have reported good results, but no robust, risk-adjusted outcomes data are available. The aims of this study were to analyze the surgical outcomes of a very large cohort of patients undergoing operations for cholangiocarcinoma in North America. Study Design: The American College of Surgeons National Surgical Quality Improvement Program Participant Use File was queried for patients with bile duct cancers. Patients (n = 839) were classified as having intrahepatic (36.5%), perihilar (34.4%), or distal (29.1%) cholangiocarcinomas by the type of procedure performed. Observed and expected (O/E) morbidity and mortality rates, O/E indices, and regression-adjusted risk factors were determined. Results: Mortality was highest for perihilar tumors that were managed with hepatectomy and biliary-enteric anastomosis (11.9%) and lowest for distal cholangiocarcinomas (1.2%). After risk adjustment, mortality was considerable greater than expected for patients undergoing hepatectomy with biliary-enteric anastomosis (O/E = 3.0) or hepatectomy alone (O/E = 2.4). Conclusions: This analysis suggests that postoperative outcomes are best for distal and worst for perihilar cholangiocarcinomas, and hepatectomy for bile duct cancers is associated with a 2- to 3-fold mortality risk. We conclude that North American surgical outcomes can be improved for patients with proximal cholangiocarcinomas.
KW - ACS
KW - American College of Surgeons
KW - BEA
KW - biliary-enteric anastomosis
KW - interquartile range
KW - IQR
KW - National Surgical Quality Improvement Program
KW - NSQIP
KW - O/E
KW - observed/expected
KW - Participant Use File
KW - PUF
UR - http://www.scopus.com/inward/record.url?scp=84872362125&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872362125&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2012.11.002
DO - 10.1016/j.jamcollsurg.2012.11.002
M3 - Article
C2 - 23266423
AN - SCOPUS:84872362125
VL - 216
SP - 192
EP - 200
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 2
ER -