Impact of Facility Type and Surgical Volume on 10-Year Survival in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma

Chapman, Brandon C.; Paniccia, Alessandro; Hosokawa, Patrick; Henderson, William G.; Overbey, Douglas M.; Messersmith, Wells A.; McCarter, Martin D.; Gleisner, Ana; Edil, Barish H.; Schulick, Richard D.; Gajdos, Csaba

doi:10.1016/j.jamcollsurg.2016.11.011

Cited by 63 publications

(44 citation statements)

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“…Several recent institutional experiences in pancreatic and hepatic resections reporting on increasingly larger older adult patient cohorts with favorable outcomes are consistent with our findings . Moreover, recent studies demonstrating trends in increased volume and improved outcomes for major upper abdominal resections driven largely by high‐volume centers are also concordant with our current results …”

Section: Discussionsupporting

confidence: 91%

“…[19][20][21][22] Moreover, recent studies demonstrating trends in increased volume and improved outcomes for major upper abdominal resections driven largely by high-volume centers are also concordant with our current results. 15,23,24 The observed trends likely can be explained by a combination of factors. First, the increase in the number of operations is largely explained by an increase in major elective surgeries of the pancreas and liver, suggesting an emboldened surgical approach in the setting of increasingly favorable mortality rates.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Neuwirth

Bierema

Sinnamon

et al. 2017

Cancer

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BACKGROUND:Although there is a general perception that, as the older population grows in number, more are undergoing surgery, there are few data on trends in major resections for cancer and short-term outcomes in this group. METHODS: The Nationwide Inpatient Sample was (NIS) used to estimate the national trends of major upper abdominal resections (esophagus, stomach, liver, pancreas) for cancer in octogenarians (aged 80 years) from 2001 to 2011. Resection rates performed per year were incidence-adjusted within this age group for each cancer type as determined by the NIS database. Joinpoint regression was used to calculate average annual percentage changes (AAPC) when evaluating trends over time. RESULTS: During the study period, octogenarians underwent an estimated 30,356 upper abdominal organ resections for cancer in the United States, representing 3.8% of all cancer admissions among octogenarians. Resection rates in octogenarians increased significantly over time (AAPC, 2.54; P < .001) secondary to increasing trends in pancreatic (AAPC, 11.52; P < .001) and hepatic (AAPC, 6.67; P < .001) resections. Elixhauser comorbidity index scores increased from a mean of 3.61 to 4.20 (AAPC, 1.31; P < .001), whereas inpatient mortality during this time decreased from 13.6% to 8.2% (AAPC, 5.58; P < .001). CONCLUSIONS: Overall rates of major upper abdominal cancer resections in octogenarians are increasing over time, driven by increases in liver and pancreatic resections. These increases were observed despite a less favorable patient morbidity profile over time. These patterns may suggest shifting selection criteria for octogenarians undergoing major abdominal surgery over time in the context of diminishing postoperative mortality. Cancer 2018;124:125-35. V C 2017 American Cancer Society.KEYWORDS: abdominal surgery, gastrointestinal cancer, national trends, octogenarian, outcomes. INTRODUCTIONOctogenarians (patients ages 80 years) have traditionally been considered at higher risk for major surgical procedures, including various types of cancer resections. This particular population is growing rapidly, with current forecasts estimating an increase in the population aged 85 years older from 1.7% of the population (5.4 million individuals) in 2008 to 7.5% of the population (projected, 27-35 million individuals) by 2050. 1 Likewise, it is estimated that adults aged 75 will increase from 18.7 million (6.1%) in 2010 to a projected 33.3 million (11%) by 2030. 2 The older population is also at the higher risk of developing cancer, with 60% of new diagnoses of malignancies occurring in those aged 65 years. 3,4 However, data reporting specific trends and outcomes in octogenarians with regard to major abdominal operations for cancer are relatively lacking. Characterization of such trends may be particularly important to help identify changes in selection criteria for surgery in this growing older adult population.Several recent studies have demonstrated similar postoperative outcomes in older adult patients compared with younger cohort...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Neuwirth

Bierema

Sinnamon

et al. 2017

Cancer

View full text Add to dashboard Cite

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“…Hospitals with a greater number and a higher complexity of therapeutic options likely treat a higher volume of patients with each treatment modality. Increased patient volume has been associated with improved outcomes for both radio frequency ablation and surgical resection in patients with HCC . Further, all transplant centers are required to have multidisciplinary medical support, and most hospitals that offer major hepatic resection would be expected to have a number of these resources available as well.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma

et al. 2018

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Multidisciplinary hepatocellular carcinoma (HCC) treatment is associated with optimal outcomes. There are few data analyzing the impact of treating hospitals' therapeutic offerings on survival. We performed a retrospective cohort study of patients aged 18-70 years with HCC in the National Cancer Database (2004-2012). Hospitals were categorized based on the level of treatment offered (Type I-nonsurgical; Type II-ablation; Type III-resection; Type IV-transplant). Associations between overall risk of death and hospital type were evaluated with multivariable Cox shared frailty modeling. Among 50,381 patients, 65% received care in Type IV hospitals, 26% in Type III, 3% in Type II, and 6% in Type I. Overall 5-year survival across modalities was highest at Type IV hospitals (untreated: Type IV-13.1% versus Type I-5.7%, Type II-7.0%, Type III-7.4% [log-rank, P < 0.001]; chemotherapy and/or radiation: Type IV-18.1% versus Type I-3.6%, Type II-4.6%, Type III-7.7% [log-rank, P < 0.001]; ablation: Type IV-33.3% versus Type II-13.6%, Type III-23.6% [log-rank, P < 0.001]; resection: Type IV-48.4% versus Type III-39.1% [log-rank, P < 0.001]). Risk of death demonstrated a dose-response relationship with the hospital type-Type I (ref); Type II (hazard ratio [HR] 0.81, 95% confidence interval [0.73-0.90]); Type III (HR 0.67 [0.62-0.72]); Type IV hospitals (HR 0.43 [0.39-0.47]). Conclusion: Although care at hospitals offering the full complement of HCC treatments is associated with decreased risk of death, one third of patients are not treated at these hospitals. These data can inform the value of health policy initiatives regarding regionalization of HCC care.

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“…However, more than 20% of 10-year survivors had microvascular invasion, poor tumor differentiation, AFP greater than 1000 ng/mL and tumor size greater than 10 cm. Long-term survival may also be influenced by surgical expertise, as Chapman et al [23] reported that centers with high volumes of resections for HCC had significantly improved 10-year survival after hepatic resection. In our study, however, the univariate analysis on hepatic resection suggested that Age ≥ 65, HBV, BMI ≥ 25, smoking, and diabetes were associated with 10-year survival.…”

Section: Treatment Modality and Survivalmentioning

confidence: 99%

Ten-year survival and recurrence of hepatocellular cancer

Sempokuya¹

2019

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Aim: Long-term survival after hepatocellular cancer (HCC) is difficult to achieve likely related to recurrence. This study aimed to identify factors that were predictive of 10-year survival after the diagnosis of HCC. Methods:In a prospectively collected database of 1374 HCC cases , we identified 70 patients who survived over 10 years regardless of treatment. We then identified 164 patients in the entire cohort who either had liver resection or transplant, and died before 10 years. Demographics, tumor characteristics, treatment, recurrence and treatment of recurrence were compared.Results: Of the 10-year survivors, 36 underwent transplant, 27 had liver resection and 7 patients had only locoregional therapy. Compared to the non-survivors, the 10-year survivors were younger and had fewer comorbidities or recurrence, smaller tumor size, lower AST, ALT, AFP, platelets, neutrophil-to-lymphocyte ratio. Multivariate analysis showed only age and diabetes to be negative predictors. Recurrence occurred in 24 survivors (34.3%) with mean time to recurrence with standard deviation 57.1 ± 42.6 months compared to 80 non-survivors (48.7%) with mean time to recurrence of 15.3 ± 14.8 months. For hepatic resection, 10-year survivors had longer time to recurrence compared to non-survivors (median: 31.3 months). Conclusion:Long-term survivors mostly occur after resection or transplant, but 10% of our cohort survived 10 years with only locoregional therapy. Underlying health status maybe an important predictor of 10-year survival for patients receiving liver resections. Recurrence of HCC occurs in both 10-year survivors and non-survivors, but later recurrence with aggressive treatment of the recurrence may allow for 10-year survival.

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Impact of Facility Type and Surgical Volume on 10-Year Survival in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma

Cited by 63 publications

References 28 publications

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma

Ten-year survival and recurrence of hepatocellular cancer

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