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01-08-2016 | Original Article

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

Authors: Stefan Buettner, Ana Wilson, Georgios Antonis Margonis, Faiz Gani, Cecilia G. Ethun, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C. G. Martin, Charles R. Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras, Rivfka Shenoy, Shishir K. Maithel, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 8/2016

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.

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Title: Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study
Authors: Stefan Buettner
Ana Wilson
Georgios Antonis Margonis
Faiz Gani
Cecilia G. Ethun
George A. Poultsides
Thuy Tran
Kamran Idrees
Chelsea A. Isom
Ryan C. Fields
Bradley Krasnick
Sharon M. Weber
Ahmed Salem
Robert C. G. Martin
Charles R. Scoggins
Perry Shen
Harveshp D. Mogal
Carl Schmidt
Eliza Beal
Ioannis Hatzaras
Rivfka Shenoy
Shishir K. Maithel
Timothy M. Pawlik
Publication date: 01-08-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 8/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3155-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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