Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study

• Type of Material: Article
• Authors: Stefan Buettner, Johns Hopkins University; Ana Wilson, Johns Hopkins University; Georgios Antonis Margonis, Johns Hopkins University; Faiz Gani, Johns Hopkins University; Cecilia G. Ethun, Emory University; George A. Poultsides, Stanford University; Thuy Tran, Stanford University; Kamran Idrees, Vanderbilt University; Chelsea A. Isom, Vanderbilt University; Ryan C. Fields, Washington University; Bradley Krasnick, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Robert C. G. Martin, University of Louisville; Charles R. Scoggins, University of Louisville; Perry Shen, Wake Forest University; Harveshp D. Mogal, Wake Forest University; Carl Schmidt, Ohio State University; Eliza Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Shishir Maithel, Emory University; Timothy M. Pawlik, Johns Hopkins University
• Language: English
• Date: 2016-08-01
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016, The Society for Surgery of the Alimentary Tract.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11605-016-3155-6
• Title of Journal or Parent Work: Journal of Gastrointestinal Surgery
• Volume: 20
• Issue: 8
• Start Page: 1444
• End Page: 1452
• Keywords: RANDOMIZED-TRIAL; Surgery; GALLBLADDER CANCER; GEMCITABINE; CISPLATIN; PROGNOSTIC-FACTORS; Science & Technology; CHOLANGIOCARCINOMA; Malignancy; BYPASS; Extrahepatic; Surgical; SURGICAL-TREATMENT; Life Sciences & Biomedicine; Gastroenterology & Hepatology; OBSTRUCTION; Biliary; Palliation; TRACT CANCER
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

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.