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) |
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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 1 2013 |
Keywords
- ACS
- American College of Surgeons
- BEA
- IQR
- NSQIP
- National Surgical Quality Improvement Program
- O/E
- PUF
- Participant Use File
- biliary-enteric anastomosis
- interquartile range
- observed/expected
ASJC Scopus subject areas
- Surgery