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Facility Type is Associated with Margin Status and Overall Survival of Patients with Resected Intrahepatic Cholangiocarcinoma

Grace C. Lee MD, T. Clark Gamblin MD, MS, MBA, Zhi Ven Fong MD, MPH, Cristina R. Ferrone MD, Lipika Goyal MD, MPhil, Keith D. Lillemoe MD, Lawrence S. Blaszkowsky MD, Kenneth K. Tanabe MD, Motaz Qadan MD, PhD
Hepatobiliary Tumors
Volume 26, Issue 12 / November , 2019

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.

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