Journal of Gastrointestinal Surgery

, Volume 16, Issue 12, pp 2225–2232 | Cite as

Surgical Management Trends for Cholangiocarcinoma in the USA 1998–2009

  • Jamie E. Anderson
  • Alan W. Hemming
  • David C. Chang
  • Mark A. Talamini
  • Kristin L. Mekeel
Original Article



Surgical advancements have improved outcomes for cholangiocarcinoma (CCA) patients, but this expertise is not uniformly available. This research examines CCA surgical treatment patterns.


A retrospective analysis of the U.S. Nationwide Inpatient Sample from 1998–2009 identified CCA patients at high-volume (HV) versus low-volume (LV) hospitals, and teaching versus nonteaching hospitals. We performed multinomial and multivariate logistic regressions to compare differences of surgical treatment between HV vs. LV hospitals, and teaching vs. nonteaching hospitals. Liver resection (LR), pancreaticoduodenectomy, bile duct (BD) resection, and combined liver/BD resection were considered more aggressive therapy than BD stent or bypass.


A total of 32,561 patients with CCA were identified. The proportion receiving surgery declined from 36 to 30 %. There was no increase in the proportion of LRs or combined liver/BD resection. Patients at HV or teaching hospitals were more likely to receive surgical treatment [odds ratio (OR), 1.3, p < 0.001; OR, 1.4, p < 0.001].


Despite increasing evidence that surgical resection increases survival, the number of patients receiving surgery has decreased. Although combined liver/BD resection has been advocated as standard management for proximal CCA, the practice has not increased. All patients with CCA should be considered for assessment at a HV teaching hospital.


Cholangiocarcinoma Outcomes research Hepatectomy Liver transplantation 


  1. 1.
    Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology 2011;54(1):173-184.PubMedCrossRefGoogle Scholar
  2. 2.
    Skipworth JR, Olde Damink SW, Imber C, Bridgewater J, Pereira SP, Malago M. Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. Aliment Pharmacol Ther 2011;34(9):1063-1078.PubMedCrossRefGoogle Scholar
  3. 3.
    de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM. Biliary tract cancers. N Engl J Med 1999;341(18):1368-1378.PubMedCrossRefGoogle Scholar
  4. 4.
    Gatto M, Alvaro D. New insights on cholangiocarcinoma. World J Gastrointest Oncol 2010;2(3):136-145.PubMedCrossRefGoogle Scholar
  5. 5.
    Young AL, Prasad KR, Toogood GJ, Lodge JP. Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds. J Hepatobiliary Pancreat Sci 2010;17(4):497-504.PubMedCrossRefGoogle Scholar
  6. 6.
    Hemming AW, Mekeel K, Khanna A, Baquerizo A, Kim RD. Portal vein resection in management of hilar cholangiocarcinoma. J Am Coll Surg 2011;212(4):604-13; discussion 613-6.PubMedCrossRefGoogle Scholar
  7. 7.
    Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 2010;252(1):115-123.PubMedCrossRefGoogle Scholar
  8. 8.
    Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, Yoshitomi H, Furukawa K, Takeuchi D, Takayashiki T, Suda K, Takano S. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. J Hepatobiliary Pancreat Sci 2010;17(4):470-475.PubMedCrossRefGoogle Scholar
  9. 9.
    Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, Furukawa K, Miyazaki M. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg 2010;251(2):281-286.PubMedCrossRefGoogle Scholar
  10. 10.
    Grandadam S, Compagnon P, Arnaud A, Olivie D, Malledant Y, Meunier B, Launois B, Boudjema K. Role of preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma type III. Ann Surg Oncol 2010;17(12):3155-3161.PubMedCrossRefGoogle Scholar
  11. 11.
    Hemming AW, Kim RD, Mekeel KL, Fujita S, Reed AI, Foley DP, Howard RJ. Portal vein resection for hilar cholangiocarcinoma. Am Surg 2006;72(7):599-604; discussion 604-5.PubMedGoogle Scholar
  12. 12.
    Heimbach JK, Haddock MG, Alberts SR, Nyberg SL, Ishitani MB, Rosen CB, Gores GJ. Transplantation for hilar cholangiocarcinoma. Liver Transpl 2004;10(10 Suppl 2):S65-8.PubMedCrossRefGoogle Scholar
  13. 13.
    Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL, Gordon TA. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 1998;2(1):11-20.PubMedCrossRefGoogle Scholar
  14. 14.
    Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg 1999;134(1):30-35.PubMedCrossRefGoogle Scholar
  15. 15.
    Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221(1):43-49.PubMedCrossRefGoogle Scholar
  16. 16.
    Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg 1998;228(1):71-78.PubMedCrossRefGoogle Scholar
  17. 17.
    Gordon TA, Bowman HM, Bass EB, Lillemoe KD, Yeo CJ, Heitmiller RF, Choti MA, Burleyson GP, Hsieh G, Cameron JL. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg 1999;189(1):46-56.PubMedCrossRefGoogle Scholar
  18. 18.
    Hollenbeck BK, Dunn RL, Miller DC, Daignault S, Taub DA, Wei JT. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol 2007;25(1):91-96.PubMedCrossRefGoogle Scholar
  19. 19.
    Agency for Healthcare Research and Quality. Overview of the Nationwide Inpatient Sample (NIS). Available at: Accessed March 2, 2011.
  20. 20.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.PubMedCrossRefGoogle Scholar
  21. 21.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46(10):1075-9; discussion 1081-90.PubMedCrossRefGoogle Scholar
  22. 22.
    Hemming AW, Reed AI, Fujita S, Zendejas I, Howard RJ, Kim RD. Role for extending hepatic resection using an aggressive approach to liver surgery. J Am Coll Surg 2008;206(5):870-5; discussion 875-8.PubMedCrossRefGoogle Scholar
  23. 23.
    Schiffman SC, Reuter NP, McMasters KM, Scoggins CR, Martin RC. Overall survival peri-hilar cholangiocarcinoma: R1 resection with curative intent compared to primary endoscopic therapy. J Surg Oncol 2012;105(1):91-96.PubMedCrossRefGoogle Scholar
  24. 24.
    Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG, Hawkins IF, Vauthey JN. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003;237(5):686-91; discussion 691-3.PubMedGoogle Scholar
  25. 25.
    Hemming AW, Magliocca JF, Fujita S, Kayler LK, Hochwald S, Zendejas I, Kim RD. Combined resection of the liver and pancreas for malignancy. J Am Coll Surg 2010;210(5):808-14, 814-6.PubMedCrossRefGoogle Scholar
  26. 26.
    Akamatsu N, Sugawara Y, Hashimoto D. Surgical strategy for bile duct cancer: Advances and current limitations. World J Clin Oncol 2011;2(2):94-107.PubMedCrossRefGoogle Scholar
  27. 27.
    Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 2005;242(4):540-4; discussion 544-7.PubMedGoogle Scholar
  28. 28.
    Dimick JB, Wainess RM, Cowan JA, Upchurch GR,Jr, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004;199(1):31-38.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Jamie E. Anderson
    • 1
  • Alan W. Hemming
    • 1
  • David C. Chang
    • 1
  • Mark A. Talamini
    • 1
  • Kristin L. Mekeel
    • 1
  1. 1.Department of SurgeryUniversity of California, San DiegoSan DiegoUSA

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