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Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma
Author(s) -
Spolverato Gaya,
Yakoob Mohammad Y.,
Kim Yuhree,
Alexandrescu Sorin,
Marques Hugo P.,
Lamelas Jorge,
Aldrighetti Luca,
Gamblin T. Clark,
Maithel Shishir K.,
Pulitano Carlo,
Bauer Todd W.,
Shen Feng,
Poultsides George A.,
Marsh J. Wallis,
Pawlik Timothy M.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29419
Subject(s) - medicine , intrahepatic cholangiocarcinoma , term (time) , resection , general surgery , surgery , oncology , physics , quantum mechanics
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. Cancer 2015;121:2730‐2739. © 2015 American Cancer Society