Facility Type is Another Factor in the Volume–Outcome Relationship for Complex Hepatopancreatobiliary Procedures

Excerpt

We would like to commend Drs. Lee, Qadan and colleagues for their recent article examining the national landscape in the management of resectable intrahepatic cholangiocarcinoma (ICC).1 As the reader is well aware, ICC is a rare solid organ malignancy with poor long-term outcomes. Due to its rarity, the majority of historical data and study designs have grouped ICC within the category of primary liver or advanced biliary tract cancers. Unfortunately, the incidence of ICC appears to be on the rise,2 likely as a result of the increased prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Surgical resection remains the cornerstone of treatment, however results remain disparaging. Anywhere from 10 to 30% of ‘potentially resectable’ patients have metastatic disease at the time of exploration.3^,4 Adding insult to injury, recurrence after curative resection is as high as 53–68%5‐7 and the likelihood of cure is low.8 Therefore, it is imperative that we as a field study every aspect of this disease process in order to optimize outcomes for this patient population. …