Changing trends in surgical outcomes after major h

Authors: Tsuyoshi Sano Kazuaki Shimada Yoshihiro Sakamoto Minoru Esaki Tomoo Kosuge

Publish Date: 2007/09/28

Volume: 14, Issue: 5, Pages: 455-462

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Abstract

Hepatobiliary resection HBR for hilar cholangiocarcinoma HCCa remains a technically demanding procedure and is still associated with significant rates of morbidity and mortality The aim of this study was to characterize changes in surgical outcomes following major HBR for HCCa at a single center over a 25year periodBetween 1980 and 2004 126 patients undergoing preoperative biliary drainage portal vein embolization and major HBR were enrolled in this study The patients were divided into two groups according to the chronological treatment period ie patients who underwent surgery during the initial 20year period 1980–1999 early group EG and those who underwent surgery during the most recent 5year period 2000–2004 late group LG Clinicopathological variables were compared retrospectively between the two groupsThe mortality rate improved from 79 in the EG to 0 in the LG but this difference did not reach the level of statistical significance P = 0058 The overall survival rate at 1 3 and 5 years was 824 439 and 352 respectively The overall survival rate was similar in the two groups P = 0153 Morbidity was documented in 571 of all the patients and was comparable in the two groups P = 0471 but the rate of major morbidity was significantly higher in the EG P = 0031 Red blood cell and fresh frozen plasma transfusion requirements were significantly reduced in the LG both in regard to the number of patients and the amount of blood product administered The mean length of postoperative hospital stay was significantly reduced from 744 + −563 days in the EG to 290 + −118 days in the LG P 0001 Sixtynine patients 548 had stage III or IV disease according to the General rules for surgical and pathological studies on cancer of the biliary tract of the Japanese Society of Biliary Surgery and 55 patients 437 showed positive surgical margins There were no differences between the two groups in terms of surgical margins or pathological stagingImprovements were documented in rates of major morbidity length of hospital stay and the mortality rate in the LG when compared with the EG The overall survival rate was similar in the two groups Blood transfusion requirements were significantly reduced in the LG when compared with the EG However the high proportion of patients with positive surgical margins remains a significant problem

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