Cholangiocarcinoma: Are north american surgical outcomes optimal?

Andrew P. Loehrer, Michael G. House, Attila Nakeeb, E. Molly Kilbane, Henry A. Pitt

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)192-200
Number of pages9
JournalJournal of the American College of Surgeons
Volume216
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Cholangiocarcinoma
Hepatectomy
Bile Duct Neoplasms
Mortality
Klatskin Tumor
Risk Adjustment
North America
Quality Improvement
Referral and Consultation
Morbidity
Neoplasms

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 journalArticle

Loehrer, Andrew P. ; House, Michael G. ; Nakeeb, Attila ; Kilbane, E. Molly ; Pitt, Henry A. / Cholangiocarcinoma : Are north american surgical outcomes optimal?. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 2. pp. 192-200.
@article{63c02c765b31483cb897d8120d17716b,
title = "Cholangiocarcinoma: Are north american surgical outcomes optimal?",
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.",
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",
author = "Loehrer, {Andrew P.} and House, {Michael G.} and Attila Nakeeb and Kilbane, {E. Molly} and Pitt, {Henry A.}",
year = "2013",
month = "2",
doi = "10.1016/j.jamcollsurg.2012.11.002",
language = "English (US)",
volume = "216",
pages = "192--200",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

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 -