Gaya Spolverato1, Mohammad Y Yakoob1, Yuhree Kim1, Sorin Alexandrescu2, Hugo P Marques3, Jorge Lamelas3, Luca Aldrighetti4, T Clark Gamblin5, Shishir K Maithel6, Carlo Pulitano7, Todd W Bauer8, Feng Shen9, George A Poultsides10, J Wallis Marsh11, Timothy M Pawlik1. 1. Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. 3. Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal. 4. Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy. 5. Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 6. Department of Surgery, Division of Surgical Oncology, Emory University, Atlanta, Georgia. 7. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia. 8. Department of Surgery, Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia. 9. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 10. Department of Surgery, Stanford University, Stanford, California. 11. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: The impact of postoperative complications on the long-term outcomes of patients undergoing surgery for cancer is unclear. The objective of the current study was to define the incidence of complications among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) and identify the association between morbidity and long-term outcomes. METHODS: A total of 583 patients undergoing surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. The association between the occurrence and severity of postoperative complications on long-term survival was analyzed. RESULTS: The median age of the patients was 59.9 years and the majority of patients were male (52.3%). A total of 91 patients (15.6%) and 153 patients (26.2%) developed a major and minor postoperative complication, respectively; 18 patients (3.5%) died within 90 days of surgery. Median, 1-year, 3-year, and 5-year recurrence-free survival were 10.0 months, 43.3%, 16.7%, and 11.1%, respectively. Postoperative complications (hazard ratio [HR], 1.37, 95% confidence interval [95% CI], 1.08-1.73 [P = .01]) and severity of complications (major vs none: HR, 1.55; 95% CI, 1.14-2.11 [P = .01]; minor vs none: HR, 1.30; 95% CI, 0.99-1.70 [P = .06]) independently predicted shorter recurrence-free survival. Median, 1-year, 3-year, and 5-year overall survival was 27.8 months, 76.8%, 39.0%, and 23.4%, respectively. Postoperative complications (HR, 1.64; 95% CI, 1.30-2.08 [P<.001]) and severity of complications (major vs none: HR, 1.79; 95% CI, 1.31-2.44 [P<.001]; minor vs none: HR, 1.50; 95% CI, 1.15-1.95 [P<.01]) independently predicted shorter overall survival. CONCLUSIONS: Postoperative complications were found to be independent predictors of worse long-term outcomes. The prevention and management of postoperative complications is crucial to increase both short-term and long-term survival.
BACKGROUND: The impact of postoperative complications on the long-term outcomes of patients undergoing surgery for cancer is unclear. The objective of the current study was to define the incidence of complications among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) and identify the association between morbidity and long-term outcomes. METHODS: A total of 583 patients undergoing surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. The association between the occurrence and severity of postoperative complications on long-term survival was analyzed. RESULTS: The median age of the patients was 59.9 years and the majority of patients were male (52.3%). A total of 91 patients (15.6%) and 153 patients (26.2%) developed a major and minor postoperative complication, respectively; 18 patients (3.5%) died within 90 days of surgery. Median, 1-year, 3-year, and 5-year recurrence-free survival were 10.0 months, 43.3%, 16.7%, and 11.1%, respectively. Postoperative complications (hazard ratio [HR], 1.37, 95% confidence interval [95% CI], 1.08-1.73 [P = .01]) and severity of complications (major vs none: HR, 1.55; 95% CI, 1.14-2.11 [P = .01]; minor vs none: HR, 1.30; 95% CI, 0.99-1.70 [P = .06]) independently predicted shorter recurrence-free survival. Median, 1-year, 3-year, and 5-year overall survival was 27.8 months, 76.8%, 39.0%, and 23.4%, respectively. Postoperative complications (HR, 1.64; 95% CI, 1.30-2.08 [P<.001]) and severity of complications (major vs none: HR, 1.79; 95% CI, 1.31-2.44 [P<.001]; minor vs none: HR, 1.50; 95% CI, 1.15-1.95 [P<.01]) independently predicted shorter overall survival. CONCLUSIONS: Postoperative complications were found to be independent predictors of worse long-term outcomes. The prevention and management of postoperative complications is crucial to increase both short-term and long-term survival.
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Authors: Xu-Feng Zhang; Fabio Bagante; Jeffery Chakedis; Dimitrios Moris; Eliza W Beal; Matthew Weiss; Irinel Popescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; Oliver Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2017-07-25 Impact factor: 3.452