TY - JOUR
T1 - Staging laparoscopy among three subtypes of extra-hepatic biliary malignancy
T2 - a 15-year experience from 10 institutions
AU - and the U.S. Extrahepatic Biliary Malignancy Consortium
AU - Davidson, Jesse T.
AU - Jin, Linda X.
AU - Krasnick, Bradley
AU - Ethun, Cecilia G.
AU - Pawlik, Timothy M.
AU - Poultsides, George A.
AU - Idrees, Kamran
AU - Weber, Sharon M.
AU - Martin, Robert C.G.
AU - Shen, Perry
AU - Hatzaras, Ioannis
AU - Maithel, Shishir K.
AU - Fields, Ryan C.
N1 - Funding Information:
Research reported in this publication was supported by the Washington University School of Medicine Surgical Oncology Basic Science and Translational Research Training program grant T32CA009621 from the National Cancer Institute (NCI) as part of the National Institutes of Health (NIH) for JTD, and BK. This study was presented in part at the American Society of Clinical Oncology Gastrointestinal Cancer Symposium; January 22, 2016; San Francisco, CA; and at the Society of Surgical OncologyAnnual Meeting; March 3, 2016; Boston, MA. The authors would like to thank the members of The U.S. Extrahepatic Biliary Malignancy Consortium groups: William G. Hawkins MD, Steven M. Strasberg MD, William C. Chapman MD, and Maria B. Majella Doyle MD, Department of Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO Eliza Beal MD and Carl R. Schmidt MD, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH Thuy Tran MD, Department of Surgery, Stanford University Medical Center, Stanford, CA Chelsea A. Isom MD, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN Ahmed Salem MD, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI Charles Scoggins MD, Department of Surgery, University of Louisville, Louisville, KY Harveshp Mogal MD, Department of Surgery, Wake Forest University, Winston-Salem, NC Rivfka Shenoy MD, Department of Surgery, New York University, New York, NY.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background: Staging laparoscopy (SL) is used to avoid resection failure and thus increase the curative resection rate. SL utilization in extra-hepatic biliary tumors (EHBT) is variable. Methods: Data from 1090 patients with potentially resectable EHBT including gallbladder (GBC), distal (DC), and hilar (HC) subtypes were retrospectively collected from 10 academic centers (2000-2015). Results: The SL utilization rate increased over time and was significantly higher in GBC than DC and HC. SL yield was 16.8% and did not differ between groups or over time. In patients undergoing attempted resection with prior SL, the curative resection rate did not differ between subtypes. In patients undergoing attempted resection without prior SL, the curative resection rate was less in GBC compared with DC or HC. After matching cohorts by inverse probability weighting, prior SL was associated with curative resection in GBC only (odds ratio [OR], 2.41, 95% CI, 1.36-4.27). On multivariable regression analysis, elevated carbohydrate antigen 19-9 (CA 19-9), low serum albumin, and GBC were strong predictors of distant disease on SL. After categorizing patients undergoing SL into low, intermediate, and high-risk groups based on these parameters, SL yield improved progressively from 10.0% to 19.6% to 52.6%. Conclusions: We recommend routine SL for patients with GBC, particularly with elevated CA19-9 level and/or decreased serum albumin.
AB - Background: Staging laparoscopy (SL) is used to avoid resection failure and thus increase the curative resection rate. SL utilization in extra-hepatic biliary tumors (EHBT) is variable. Methods: Data from 1090 patients with potentially resectable EHBT including gallbladder (GBC), distal (DC), and hilar (HC) subtypes were retrospectively collected from 10 academic centers (2000-2015). Results: The SL utilization rate increased over time and was significantly higher in GBC than DC and HC. SL yield was 16.8% and did not differ between groups or over time. In patients undergoing attempted resection with prior SL, the curative resection rate did not differ between subtypes. In patients undergoing attempted resection without prior SL, the curative resection rate was less in GBC compared with DC or HC. After matching cohorts by inverse probability weighting, prior SL was associated with curative resection in GBC only (odds ratio [OR], 2.41, 95% CI, 1.36-4.27). On multivariable regression analysis, elevated carbohydrate antigen 19-9 (CA 19-9), low serum albumin, and GBC were strong predictors of distant disease on SL. After categorizing patients undergoing SL into low, intermediate, and high-risk groups based on these parameters, SL yield improved progressively from 10.0% to 19.6% to 52.6%. Conclusions: We recommend routine SL for patients with GBC, particularly with elevated CA19-9 level and/or decreased serum albumin.
KW - biliary cancer
KW - cholangiocarcinoma
KW - staging laparoscopy
UR - http://www.scopus.com/inward/record.url?scp=85059057000&partnerID=8YFLogxK
U2 - 10.1002/jso.25323
DO - 10.1002/jso.25323
M3 - Article
C2 - 30586170
AN - SCOPUS:85059057000
SN - 0022-4790
VL - 119
SP - 288
EP - 294
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
IS - 3
ER -