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Erschienen in: Journal of Gastrointestinal Surgery 8/2016

27.04.2016 | Original Article

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

verfasst von: 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

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 8/2016

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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.
Literatur
1.
Zurück zum Zitat Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–2917.CrossRefPubMed Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–2917.CrossRefPubMed
3.
Zurück zum Zitat Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol. 2004;30(8):842–846.CrossRefPubMed Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol. 2004;30(8):842–846.CrossRefPubMed
4.
Zurück zum Zitat Lepage C, Capocaccia R, Hackl M, Lemmens V, Molina E, Pierannunzio D, Sant M, Trama A, Faivre J, Grouph E-W. Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007: Results of EUROCARE-5. Eur J Cancer. 2015. Lepage C, Capocaccia R, Hackl M, Lemmens V, Molina E, Pierannunzio D, Sant M, Trama A, Faivre J, Grouph E-W. Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007: Results of EUROCARE-5. Eur J Cancer. 2015.
6.
Zurück zum Zitat Taylor MC, McLeod RS, Langer B. Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: a meta-analysis. Liver Transpl. 2000;6(3):302–308.CrossRefPubMed Taylor MC, McLeod RS, Langer B. Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: a meta-analysis. Liver Transpl. 2000;6(3):302–308.CrossRefPubMed
7.
Zurück zum Zitat Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344(8938):1655–1660.CrossRefPubMed Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344(8938):1655–1660.CrossRefPubMed
8.
Zurück zum Zitat Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, Matzen P. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30(8):1132–1135.CrossRefPubMedPubMedCentral Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, Matzen P. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30(8):1132–1135.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, Park JS, Yoon MH, Cho JY, Hong TH, Hwang DW, Choi DW, Korean Association of H-B, Pancreas S. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci. 2014;29(10):1333–1340.CrossRefPubMedPubMedCentral Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, Park JS, Yoon MH, Cho JY, Hong TH, Hwang DW, Choi DW, Korean Association of H-B, Pancreas S. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci. 2014;29(10):1333–1340.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Pradeep R, Kaushik SP, Sikora SS, Bhattacharya BN, Pandey CM, Kapoor VK. Predictors of survival in patients with carcinoma of the gallbladder. Cancer. 1995;76(7):1145–1149.CrossRefPubMed Pradeep R, Kaushik SP, Sikora SS, Bhattacharya BN, Pandey CM, Kapoor VK. Predictors of survival in patients with carcinoma of the gallbladder. Cancer. 1995;76(7):1145–1149.CrossRefPubMed
11.
Zurück zum Zitat Cunningham SC, Choti MA, Bellavance EC, Pawlik TM. Palliation of hepatic tumors. Surg Oncol. 2007;16(4):277–291.CrossRefPubMed Cunningham SC, Choti MA, Bellavance EC, Pawlik TM. Palliation of hepatic tumors. Surg Oncol. 2007;16(4):277–291.CrossRefPubMed
12.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Amini N, Spolverato G, Kim Y, Pawlik TM. Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery. J Gastrointest Surg. 2015;19(9):1581–1592.CrossRefPubMed Amini N, Spolverato G, Kim Y, Pawlik TM. Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery. J Gastrointest Surg. 2015;19(9):1581–1592.CrossRefPubMed
14.
Zurück zum Zitat Ishihara S, Miyakawa S, Takada T, Takasaki K, Nimura Y, Tanaka M, Miyazaki M, Nagakawa T, Kayahara M, Horiguchi A. Status of surgical treatment of biliary tract cancer. Dig Surg. 2007;24(2):131–136.CrossRefPubMed Ishihara S, Miyakawa S, Takada T, Takasaki K, Nimura Y, Tanaka M, Miyazaki M, Nagakawa T, Kayahara M, Horiguchi A. Status of surgical treatment of biliary tract cancer. Dig Surg. 2007;24(2):131–136.CrossRefPubMed
15.
Zurück zum Zitat de Aretxabala X, Roa I, Hepp J, Maluenda F, Mordojovich G, Leon J, Roa JC. Early gallbladder cancer: is further treatment necessary? J Surg Oncol. 2009;100(7):589–593.CrossRefPubMed de Aretxabala X, Roa I, Hepp J, Maluenda F, Mordojovich G, Leon J, Roa JC. Early gallbladder cancer: is further treatment necessary? J Surg Oncol. 2009;100(7):589–593.CrossRefPubMed
16.
Zurück zum Zitat Kayahara M, Nagakawa T. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer. 2007;110(3):572–580.CrossRefPubMed Kayahara M, Nagakawa T. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer. 2007;110(3):572–580.CrossRefPubMed
17.
Zurück zum Zitat Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, Cappellani A, Malfermoni G, Iacono C. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33(6):1247–1254.CrossRefPubMed Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, Cappellani A, Malfermoni G, Iacono C. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33(6):1247–1254.CrossRefPubMed
18.
Zurück zum Zitat de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Bauer TW, Walters DM, Gamblin TC, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Schulick RD, Choti MA, Gigot JF, Mentha G, Pawlik TM. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29(23):3140–3145.CrossRefPubMed de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Bauer TW, Walters DM, Gamblin TC, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Schulick RD, Choti MA, Gigot JF, Mentha G, Pawlik TM. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29(23):3140–3145.CrossRefPubMed
19.
Zurück zum Zitat Muller BG, De Aretxabala X, Gonzalez Domingo M. A review of recent data in the treatment of gallbladder cancer: what we know, what we do, and what should be done. Am Soc Clin Oncol Educ Book. 2014:e165-170. Muller BG, De Aretxabala X, Gonzalez Domingo M. A review of recent data in the treatment of gallbladder cancer: what we know, what we do, and what should be done. Am Soc Clin Oncol Educ Book. 2014:e165-170.
20.
Zurück zum Zitat Sanchez JA, Newman KD, Eichelberger MR, Nauta RJ. The papillary-cystic neoplasm of the pancreas. An increasingly recognized clinicopathologic entity. Arch Surg. 1990;125(11):1502–1505.CrossRefPubMed Sanchez JA, Newman KD, Eichelberger MR, Nauta RJ. The papillary-cystic neoplasm of the pancreas. An increasingly recognized clinicopathologic entity. Arch Surg. 1990;125(11):1502–1505.CrossRefPubMed
21.
Zurück zum Zitat Gurusamy KS, Li J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. 2009(4):CD007338.PubMed Gurusamy KS, Li J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. 2009(4):CD007338.PubMed
22.
Zurück zum Zitat Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. 2012;5:CD007338.PubMed Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. 2012;5:CD007338.PubMed
23.
Zurück zum Zitat Kim Y, Ejaz A, Gani F, Wasey JO, Xu L, Frank SM, Pawlik TM. Crystalloid administration among patients undergoing liver surgery: Defining patient- and provider-level variation. Surgery. 2016;159(2):389–398.CrossRefPubMed Kim Y, Ejaz A, Gani F, Wasey JO, Xu L, Frank SM, Pawlik TM. Crystalloid administration among patients undergoing liver surgery: Defining patient- and provider-level variation. Surgery. 2016;159(2):389–398.CrossRefPubMed
24.
Zurück zum Zitat Mukai T, Yasuda I, Nakashima M, Doi S, Iwashita T, Iwata K, Kato T, Tomita E, Moriwaki H. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci. 2013;20(2):214–222.CrossRefPubMed Mukai T, Yasuda I, Nakashima M, Doi S, Iwashita T, Iwata K, Kato T, Tomita E, Moriwaki H. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci. 2013;20(2):214–222.CrossRefPubMed
25.
Zurück zum Zitat Connor S, Barron E, Redhead DN, Ireland H, Madhavan KK, Parks RW, Garden OJ. Palliation for suspected unresectable hilar cholangiocarcinoma. Eur J Surg Oncol. 2007;33(3):341–345.CrossRefPubMed Connor S, Barron E, Redhead DN, Ireland H, Madhavan KK, Parks RW, Garden OJ. Palliation for suspected unresectable hilar cholangiocarcinoma. Eur J Surg Oncol. 2007;33(3):341–345.CrossRefPubMed
26.
Zurück zum Zitat Ercan M, Bostanci EB, Cakir T, Karaman K, Ozer I, Ulas M, Dalgic T, Ozogul Y, Aksoy E, Akoglu M. The rationality of resectional surgery and palliative interventions in the management of patients with gallbladder cancer. Am Surg. 2015;81(6):591–599.PubMed Ercan M, Bostanci EB, Cakir T, Karaman K, Ozer I, Ulas M, Dalgic T, Ozogul Y, Aksoy E, Akoglu M. The rationality of resectional surgery and palliative interventions in the management of patients with gallbladder cancer. Am Surg. 2015;81(6):591–599.PubMed
27.
Zurück zum Zitat Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J, ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010 Apr 8; 362(14):1273–81. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J, ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010 Apr 8; 362(14):1273–81.
28.
Zurück zum Zitat Okusaka T, Nakachi K, Fukutomi A, Mizuno N, Ohkawa S, Funakoshi A, Nagino M, Kondo S, Nagaoka S, Funai J, Koshiji M, Nambu Y, Furuse J, Miyazaki M, Nimura Y. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer. 2010 Aug 10; 103(4):469–74. Okusaka T, Nakachi K, Fukutomi A, Mizuno N, Ohkawa S, Funakoshi A, Nagino M, Kondo S, Nagaoka S, Funai J, Koshiji M, Nambu Y, Furuse J, Miyazaki M, Nimura Y. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer. 2010 Aug 10; 103(4):469–74.
Metadaten
Titel
Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study
verfasst von
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
Publikationsdatum
27.04.2016
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 8/2016
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3155-6

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