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 journalArticlepeer-review


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
Issue number2
StatePublished - Feb 1 2013


  • ACS
  • American College of Surgeons
  • BEA
  • IQR
  • National Surgical Quality Improvement Program
  • O/E
  • PUF
  • Participant Use File
  • biliary-enteric anastomosis
  • interquartile range
  • observed/expected

ASJC Scopus subject areas

  • Surgery


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