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



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.



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).



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.
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Stefan
S
Buettner
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Ana
A
Wilson
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Georgios Antonis
GA
Margonis
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Faiz
F
Gani
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Cecilia G
CG
Ethun
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
George A
GA
Poultsides
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Thuy
T
Tran
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Kamran
K
Idrees
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Chelsea A
CA
Isom
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ryan C
RC
Fields
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Bradley
B
Krasnick
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sharon M
SM
Weber
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed
A
Salem
Department of Surgery, University of Louisville, Louisville, KY, USA.
Robert C G
RC
Martin
Department of Surgery, University of Louisville, Louisville, KY, USA.
Charles R
CR
Scoggins
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Perry
P
Shen
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Harveshp D
HD
Mogal
Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Carl
C
Schmidt
Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Eliza
E
Beal
Department of Surgery, New York University, New York, NY, USA.
Ioannis
I
Hatzaras
Department of Surgery, New York University, New York, NY, USA.
Rivfka
R
Shenoy
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Shishir K
SK
Maithel
Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000639:trends*; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D013530:Surgical Wound Infection; D014057:Tomography, X-Ray Computed
Biliary; Extrahepatic; Malignancy; Palliation; Surgical