Bile duct surgery in the treatment of hepatobiliary and XXXX : effects of hepatic and vascular resection on outcomes.

@entity1 @entity1085 @entity326 @entity5 @entity254 @entity201 @entity358 @entity204
BACKGROUND: Resection of the bile duct is required for the treatment of @entity201 and is sometimes indicated in resections of liver and @entity1085 . The goal of this retrospective review was to characterize surgical outcomes in @entity1 submitted to bile duct resection for @entity5 when additional procedures, specifically hepatic or vascular resections, were performed. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was searched to identify a total of 747 @entity1 who underwent: (i) biliary-enteric @entity254 (BEA) only (Group  1, n  =  266); (ii) BEA with hepatic resection (Group  2, n  =  439), or (iii) BEA with hepatic and vascular resection (Group  3, n  =  42). Postoperative outcomes were compared and regression-adjusted risk factors were analysed to produce observed and expected (O/E) morbidity and mortality ratios. RESULTS: The performance of hepatic and vascular resections significantly increased rates of overall morbidity (P  <  0.001) and mortality (P  =  0.021). Risk-adjusted O/E mortality ratios in Groups 1, 2 and 3 were 1.44 [95% confidence interval (CI) 0.84-2.30], 2.16 (95% CI 1.51-2.98) and 5.92 (95% CI 2.54-11.66), respectively. Multivariate analysis identified Group  2 (P  <  0.001) and Group  3 (P  =  0.001) status as independent predictors of morbidity, and Group  3 status (P  =  0.008) as independently associated with mortality. More than 30% of @entity204 were associated with @entity358 and @entity326 . CONCLUSIONS: The addition of hepatic and vascular resections to bile duct resection significantly increased morbidity and mortality. The high O/E mortality ratios for @entity1 in Groups 2 and 3 suggest these outcomes can be improved.
