Background and objective:Although pre-operative biliary drainage(PBD)is frequently performed in patients with cholangiocarcinoma(CCA),its impact on patient survival is unclear.Our aim was to evaluate the impact of PBD...Background and objective:Although pre-operative biliary drainage(PBD)is frequently performed in patients with cholangiocarcinoma(CCA),its impact on patient survival is unclear.Our aim was to evaluate the impact of PBD on overall survival of patients with extra-hepatic CCA.Methods:This was a retrospective study using the Surveillance,Epidemiology,and End Results(SEER)-Medicare data.Patients who underwent biliary drainage within 3 months prior to and/or after diagnosis of CCA were included in the PBD cohort.Patients who did not receive biliary drainage were included in the non-PBD cohort.Cox proportional hazard regression was used to determine independent predictors of survival.Results:Of 3862 patients with extra-hepatic CCA,433(11.2%)underwent curative surgical resection,with a median survival of 14 months(95%confidence interval[95%CI],10-21months)in the PBD cohort(n=126)vs 31 months(95%CI,26-39 months)in the non-PBD cohort(n=307)(P<0.001),during the median follow-up duration for the surgical cohort of 26 months(range,1-60 months).Among the 433 patients,126(29.1%)underwent PBD and had significantly higher Charlson comorbidity index and advanced SEER stage than those without PBD before surgery.On multivariable analysis in patients who underwent curative surgical resection,after adjusting patient demographics,tumor characteristics,Charlson comorbidity index,radiotherapy and chemotherapy,PBD was significantly associated with shortened survival time(hazard ratio,2.35;95%CI,1.34-4.10;P=0.003).Conclusions:PBD appears negative impact on long-term survival in patients with potentially resectable CCA and should be avoided if possible.展开更多
Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence...Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United States.The aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the USA.Methods.We utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge diagnosis.The temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for trends.Results.There was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in 2012.The in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).Conclusions.There was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and 2012.However,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.展开更多
Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ERCP)outcomes and adverse events.Methods:All ERCP procedures,performed by experie...Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ERCP)outcomes and adverse events.Methods:All ERCP procedures,performed by experienced advanced endoscopists,in patients without prior papillary intervention from 2006 to 2008 were reviewed.Procedures were arbitrarily divided into two groups:shorter procedures(SP),with a duration shorter than the overall mean procedure length,and longer procedures(LP),with a duration longer than overall mean procedure length.Length of procedure was defined as the time from endoscope insertion to endoscope removal.Results:Two hundred and ninety-five procedures were included in the analysis.Mean procedure length was 45.630.1 min.One hundred and seventy-seven procedures(60%)were SP and 118(40%)were LP.There were no differences between the groups with regard to patients’ages,genders,race,or trainee participation.SP cases were more likely to be biliary vs pancreatic or bi-ductal evaluations(P=0.03).LP had significantly higher complexity scores(34%with>3 vs 13%;P=0.046)and were more likely to require pre-cut papillotomy(39%vs 15%;P<0.001).There was no significant difference between the groups in overall completion rates(91.5%LP vs 96%SP;P=0.10)or adverse events(10.2%LP vs 6.2%SP;P=0.21).However,LP cases were associated with higher rates of post-ERCP bleeding(4.2%vs 0.6%;P=0.029).Conclusion:There was no significant difference in outcomes or overall adverse events between shorter and longer ERCP procedures.However,longer procedures were associated with higher procedure complexity,higher utilization of pre-cut technique,and increased risk of bleeding.展开更多
文摘Background and objective:Although pre-operative biliary drainage(PBD)is frequently performed in patients with cholangiocarcinoma(CCA),its impact on patient survival is unclear.Our aim was to evaluate the impact of PBD on overall survival of patients with extra-hepatic CCA.Methods:This was a retrospective study using the Surveillance,Epidemiology,and End Results(SEER)-Medicare data.Patients who underwent biliary drainage within 3 months prior to and/or after diagnosis of CCA were included in the PBD cohort.Patients who did not receive biliary drainage were included in the non-PBD cohort.Cox proportional hazard regression was used to determine independent predictors of survival.Results:Of 3862 patients with extra-hepatic CCA,433(11.2%)underwent curative surgical resection,with a median survival of 14 months(95%confidence interval[95%CI],10-21months)in the PBD cohort(n=126)vs 31 months(95%CI,26-39 months)in the non-PBD cohort(n=307)(P<0.001),during the median follow-up duration for the surgical cohort of 26 months(range,1-60 months).Among the 433 patients,126(29.1%)underwent PBD and had significantly higher Charlson comorbidity index and advanced SEER stage than those without PBD before surgery.On multivariable analysis in patients who underwent curative surgical resection,after adjusting patient demographics,tumor characteristics,Charlson comorbidity index,radiotherapy and chemotherapy,PBD was significantly associated with shortened survival time(hazard ratio,2.35;95%CI,1.34-4.10;P=0.003).Conclusions:PBD appears negative impact on long-term survival in patients with potentially resectable CCA and should be avoided if possible.
文摘Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United States.The aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the USA.Methods.We utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge diagnosis.The temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for trends.Results.There was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in 2012.The in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).Conclusions.There was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and 2012.However,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.
文摘Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ERCP)outcomes and adverse events.Methods:All ERCP procedures,performed by experienced advanced endoscopists,in patients without prior papillary intervention from 2006 to 2008 were reviewed.Procedures were arbitrarily divided into two groups:shorter procedures(SP),with a duration shorter than the overall mean procedure length,and longer procedures(LP),with a duration longer than overall mean procedure length.Length of procedure was defined as the time from endoscope insertion to endoscope removal.Results:Two hundred and ninety-five procedures were included in the analysis.Mean procedure length was 45.630.1 min.One hundred and seventy-seven procedures(60%)were SP and 118(40%)were LP.There were no differences between the groups with regard to patients’ages,genders,race,or trainee participation.SP cases were more likely to be biliary vs pancreatic or bi-ductal evaluations(P=0.03).LP had significantly higher complexity scores(34%with>3 vs 13%;P=0.046)and were more likely to require pre-cut papillotomy(39%vs 15%;P<0.001).There was no significant difference between the groups in overall completion rates(91.5%LP vs 96%SP;P=0.10)or adverse events(10.2%LP vs 6.2%SP;P=0.21).However,LP cases were associated with higher rates of post-ERCP bleeding(4.2%vs 0.6%;P=0.029).Conclusion:There was no significant difference in outcomes or overall adverse events between shorter and longer ERCP procedures.However,longer procedures were associated with higher procedure complexity,higher utilization of pre-cut technique,and increased risk of bleeding.
