You are here
Overall survival and resection margin after hepatectomy for intrahepatic cholangiocarcinoma at academic cancer centers versus community cancer centers.
Background: Margin status is an important prognostic factor of survival following hepatectomy for intrahepatic cholangiocarcinoma (ICC). R0 resection for ICC correlates with improved recurrence-free survival and overall survival (OS). The present study hypothesized that surgical resection margins and survival rates vary between centers. Methods: Patients with ICC undergoing hepatectomy were identified from the National Cancer Database (1998-2011). Treating centers were categorized as Academic Cancer Centers (ACC), and Community Cancer Centers (CCC). Rates of R0 vs. R1/2 resection were examined. OS was analyzed by Kaplan-Meier method, and Cox multivariate modeling identified independent predictors of survival. Results: A total of 2,774 patients were identified. Hepatectomy was most often performed at ACC compared to CCC: 1,928 (69.5%) vs. 846 (30.5%). Hepatectomy at ACC was associated with higher rates of R0 resections compared to CCC (72.5% vs. 68.1%, p= 0.018). Higher 30-day readmission rates were seen following hepatectomy at ACC (9.9% vs. 5.7%, p= 0.002). Improved median OS was seen in ACC across all stages (25.8 months vs. 20.1 months; p< 0.001). After adjusting for age, sex, ethnicity, cirrhosis, alpha-feto protein level, comorbidity, disease stage, and margin status, hepatectomy at ACC was independently associated with improved OS (Hazards ratio: 0.79 [95%CI 0.62-0.99, p= 0.046]). Conclusions: ACC have higher rates of negative resection margins for ICC, but higher readmission rates following surgery. Survival is higher at ACC compared to CCC, suggesting that site of care plays a role in patient outcomes.
Abstracts by Nicholas Gerard Berger:
A multi-institutional analysis of duodenal neuroendocrine tumors: Tumor biology rather than extent of resection to dictate prognosis.Meeting: 2016 Gastrointestinal Cancers Symposium | Abstract No: 255
Conditional probability of survival in gallbladder carcinoma as a prognostic tool for long term survivors.Meeting: 2016 Gastrointestinal Cancers Symposium | Abstract No: 455