Many facilities rarely perform perihilar cholangiocarcinoma resections, found a new study published in the Journal of Gastrointestinal Surgery.

In those that do, the 90-day mortality outcomes are related to the volume of resections performed. The lower mortality outcomes were recorded in facilities that perform at least 7 resections per year. The postoperative outcomes are also improved in such facilities.

“Our data suggest that regionalization of care for patients with perihilar cholangiocarcinoma could potentially improve outcomes in the USA,” the study authors concluded.

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A team of researchers, led by Lee M. Ocuin, MD, from the University Hospitals Cleveland Medical Center in Ohio, set out to determine the minimum threshold of annual facility case volume and to optimize outcomes for patients who undergo resection of perihilar cholangiocarcinoma.

They identified patients with localized perihilar cholangiocarcinoma who underwent resection between 2010 and 2017 using the National Cancer Database. They then calculated the average effect of being treated in a facility meeting or exceeding the minimum threshold of resections per year on 90-day mortality and other postoperative outcomes. 

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During that period, 2471 patients underwent resection at 471 facilities. The number of cases of total hepatopancreatobiliary, surgical hepatopancreatobiliary, total hepatobiliary, surgical hepatobiliary, or total perihilar cholangiocarcinoma being treated at the center had no effect on 90-day mortality.

However, the number of perihilar cholangiocarcinoma resections performed in a year did have an effect on 90-day mortality, with facilities meeting a threshold of 7 resections or more per year having lower odds of 90-day mortality. 

Patients being treated at such facilities also had lower odds of staying in the hospital for 7 or more days following the operation. 

Finally, patients who had surgery in such facilities had positive surgical resection margins and higher lymph node yields. However, their odds of nodal positivity remained the same. Also, there was no difference between these facilities and others in terms of 30-day mortality rates and readmission.


Elshami M, Hue JJ, Ahmed FA, et al. Defining facility volume threshold for optimization of short- and long-term outcomes in patients undergoing resection of perihilar cholangiocarcinoma. J Gastrointest Surg. Published online September 22, 2022. doi:10.1007/s11605-022-05465-z