Faculty Collaboration Database

Facility Type is Associated with Margin Status and Overall Survival of Patients with Resected Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2019 Nov;26(12):4091-4099

Date

08/02/2019

Pubmed ID

31368018

Pubmed Central ID

PMC6788972

DOI

10.1245/s10434-019-07657-5

Scopus ID

2-s2.0-85069952082 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

BACKGROUND: Many studies have demonstrated associations between surgical resections at academic centers and improved outcomes, particularly for complex operations. However, few studies have examined this relationship in intrahepatic cholangiocarcinoma (ICC). The hypothesis of this study was that facility type is associated with improved postoperative outcomes and survival for patients with ICC who undergo resection.

METHODS: Patients with stages 1 to 3 ICC who underwent hepatectomy were identified using the National Cancer Database (NCDB) (2004-2014). Facilities were categorized as academic or community centers per Commission on Cancer designations. High-volume hospitals were those that performed 11 or more hepatectomies per year. Multilevel logistic mixed-effects models to identify predictors of outcomes and parametric survival-time models were used to determine overall survival (OS).

RESULTS: The study identified 2256 patients. Of these patients, 423 (18.8%) were treated at community centers, and 1833 (81.3%) were treated at academic centers. Nearly all high-volume centers were academic facilities (98.5% academic vs. 1.5% community centers), whereas low-volume centers were mixed (65.5% academic vs. 34.5% community centers) (p < 0.001). Surgery performed at an academic center was an independent predictor of decreased positive margins (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.51-0.98; p = 0.04), a lower 90-day mortality rate (OR, 0.62; 95% CI, 0.39-0.97; p = 0.03), and improved OS (hazard ratio [HR], 0.78; 95% CI, 0.63-0.96; p = 0.02). Facility hepatectomy volume was not independently associated with any short- or long-term outcomes.

CONCLUSIONS: Treatment at an academic center is associated with fewer positive resection margins, a decreased 90-day mortality rate, and improved OS for patients who undergo ICC resection. Facility surgical volume was not shown to be significantly associated with any postoperative outcomes after adjustment for patient and disease characteristics.

Author List

Lee GC, Gamblin TC, Fong ZV, Ferrone CR, Goyal L, Lillemoe KD, Blaszkowsky LS, Tanabe KK, Qadan M

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Bile Duct Neoplasms
Cancer Care Facilities
Cholangiocarcinoma
Female
Follow-Up Studies
Hepatectomy
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Margins of Excision
Prognosis
Retrospective Studies
Survival Rate