Post-operative morbidity results in decreased long-term survival after resection for hilar cholangiocarcinoma

Aakash Chauhan, Michael House, Henry A. Pitt, Attila Nakeeb, Thomas Howard, Nicholas Zyromski, C. Schmidt, Chad G. Ball, Keith D. Lillemoe

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: The purpose of the present study was to demonstrate that post-operative morbidity (PM) associated with resections of hilar cholangiocarcinoma (HCCA) is associated with short- and long-term patient survival. Methods: Between 1998 and 2008, 51 patients with a median age of 64 years underwent resection for HCCA at a single institution. Associations between survival and clinicopathologic factors, including peri- and post-operative variables, were studied using univariate and multivariate models. Results: Seventy-six per cent of patients underwent major hepatectomy with resection of the extrahepatic bile ducts. The 30- and 90-day operative mortality was 10% and 12%. The overall incidence of PM was 69%, with 68% of all PM as major (Clavien grades III-V). No difference in operative blood loss or peri-operative transfusion rates was observed for patients with major vs. minor or no PM. Patients with major PM received adjuvant chemotherapy less frequently than patients with minor or no complications 29% vs. 52%, P= 0.15. The 1-, 3- and 5-year overall (OS) and disease-specific survival (DSS) rates for all patients were 65%, 36%, 29% and 77%, 46%, 35%, respectively. Using univariate and multivariate analysis, margin status (27% R1), nodal metastasis (35% N1) and major PM were associated with OS and DSS, P < 0.01. Major PM was an independent factor associated with decreased OS and DSS [hazard ratio (HR) = 3.6 and 2.8, respectively, P < 0.05]. The median DSS for patients with major PM was 14 months compared with 40 months for patients who experienced minor or no PM, P < 0.01. Conclusion: Extensive operations for HCCA can produce substantial post-operative morbidity. In addition to causing early mortality, major post-operative complications are associated with decreased long-term cancer-specific survival after resection of HCCA.

Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalHPB
Volume13
Issue number2
DOIs
StatePublished - Feb 2011

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Klatskin Tumor
Morbidity
Survival
Extrahepatic Bile Ducts
Mortality
Hepatectomy
Adjuvant Chemotherapy

Keywords

  • cholangiocarcinoma
  • morbidity
  • mortality
  • outcomes
  • resection

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Post-operative morbidity results in decreased long-term survival after resection for hilar cholangiocarcinoma. / Chauhan, Aakash; House, Michael; Pitt, Henry A.; Nakeeb, Attila; Howard, Thomas; Zyromski, Nicholas; Schmidt, C.; Ball, Chad G.; Lillemoe, Keith D.

In: HPB, Vol. 13, No. 2, 02.2011, p. 139-147.

Research output: Contribution to journalArticle

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abstract = "Background: The purpose of the present study was to demonstrate that post-operative morbidity (PM) associated with resections of hilar cholangiocarcinoma (HCCA) is associated with short- and long-term patient survival. Methods: Between 1998 and 2008, 51 patients with a median age of 64 years underwent resection for HCCA at a single institution. Associations between survival and clinicopathologic factors, including peri- and post-operative variables, were studied using univariate and multivariate models. Results: Seventy-six per cent of patients underwent major hepatectomy with resection of the extrahepatic bile ducts. The 30- and 90-day operative mortality was 10{\%} and 12{\%}. The overall incidence of PM was 69{\%}, with 68{\%} of all PM as major (Clavien grades III-V). No difference in operative blood loss or peri-operative transfusion rates was observed for patients with major vs. minor or no PM. Patients with major PM received adjuvant chemotherapy less frequently than patients with minor or no complications 29{\%} vs. 52{\%}, P= 0.15. The 1-, 3- and 5-year overall (OS) and disease-specific survival (DSS) rates for all patients were 65{\%}, 36{\%}, 29{\%} and 77{\%}, 46{\%}, 35{\%}, respectively. Using univariate and multivariate analysis, margin status (27{\%} R1), nodal metastasis (35{\%} N1) and major PM were associated with OS and DSS, P < 0.01. Major PM was an independent factor associated with decreased OS and DSS [hazard ratio (HR) = 3.6 and 2.8, respectively, P < 0.05]. The median DSS for patients with major PM was 14 months compared with 40 months for patients who experienced minor or no PM, P < 0.01. Conclusion: Extensive operations for HCCA can produce substantial post-operative morbidity. In addition to causing early mortality, major post-operative complications are associated with decreased long-term cancer-specific survival after resection of HCCA.",
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AU - Pitt, Henry A.

AU - Nakeeb, Attila

AU - Howard, Thomas

AU - Zyromski, Nicholas

AU - Schmidt, C.

AU - Ball, Chad G.

AU - Lillemoe, Keith D.

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