Impact of complications on long-term survival after resection of intrahepatic cholangiocarcinoma

Gaya Spolverato; Mohammad Y Yakoob; Yuhree Kim; Sorin Alexandrescu; Hugo P Marques; Jorge Lamelas; Luca Aldrighetti; T Clark Gamblin; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; J Wallis Marsh; Timothy M Pawlik

doi:10.1002/cncr.29419

Impact of complications on long-term survival after resection of intrahepatic cholangiocarcinoma

Cancer. 2015 Aug 15;121(16):2730-9. doi: 10.1002/cncr.29419. Epub 2015 Apr 22.

Authors

Affiliations

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.

PMID: 25903409
DOI: 10.1002/cncr.29419

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.

Keywords: complications; intrahepatic cholangiocarcinoma; recurrence; survival.

MeSH terms

Aged
Bile Duct Neoplasms / mortality*
Bile Duct Neoplasms / surgery*
Bile Ducts, Intrahepatic / surgery*
Cholangiocarcinoma / mortality*
Cholangiocarcinoma / surgery*
Female
Humans
Male
Middle Aged
Morbidity
Postoperative Complications / mortality*