| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 104 === Background and Purposes:
Malignant carcinoma is the leading cause of national mortality, where hepatocellular carcinoma and intrahepatic cholangiocarcinoma is the second most common form of cancer deaths in this country. Many studies have reported an increase in global morbidity and mortality incidences of intrahepatic cholangiocarcinoma with poor prognosis. Patients are presented to the clinic with advanced stages of intrahepatic cholangiocarcinoma therefore only about 30% to 40% meet the criteria for surgical intervention.This study aims to investigate the incidences of liver resection for intrahepatic cholangiocarcinoma and conduct a trend analysis into medical resource utilization and management for hospital stays, as well as treatment efficacy of intrahepatic cholangiocarcinoma patients who underwent liver resection.
Methodology:
This study is a retrospective longitudinal study of secondary data sources (Retrospective longitudinal study). Cases were selected from the "National Health Insurance Research Database, Diseases diagnosis of intrahepatic cholangiocarcinoma and liver resection codes (ICD-9-CM 1551, 5022, 503). The study cases were selected between 1999-2012, inclusion criterion is intrahepatic cholangiocarcinoma patients who underwent liver resection( partial hepatectomy or lobectomy). Statistical analysis was conducted in the “SPSS for Windows 20.0” statistical software package.
Results:
The incident rate, per 100 000 persons, of intrahepatic cholangiocarcinoma over a 14 year period had increased from 0.35 to 0.77, with an annual increase trend observed. Majority of cases were female with an average age of 63.07 years, and most common surgical intervention is partial hepatectomy n=724 (57.3%). Several factors affected the length of hospital stay, and costs, including age, hepatitis B, the severity of complications, type of surgical intervention, physician attendance and era of admission. In intrahepatic cholangiocarcinoma survival rate, there was no significant correlation between partial hepatectomy or lobectomy(P = 0.496), nor is there between healthy and diseased patients (P = 0.984). Mortality risk assessment in patients with intrahepatic cholangiocarcinoma surgery aged 75 years, when compared to 54 years, showed an age-related risk of 1.49-fold; the severity of Charlson comorbidity index (CCI) 3-5 had a risk of mortality 1.27 times that of CCI-2, CCI 6 had a risk of mortality 2.79 times that of CCI-2. Era T2''s risk of mortality is 0.76 times that of Era T1 (P <0.003); the risk of mortality for Era T3 is 0.27 times that of Era T1 (P <0.001). In surgical treatment, however,lobectomy had an increased risk of mortality of 1.06 times, but there was no significant difference overall (P = 0.503).
Conclusions:
The study observed an annual increase in the incidences of intrahepatic cholangiocarcinoma cases requiring surgical intervention, accompanied by a decrease in the duration of hospital stays and costs over the study’s designated eras. Hospital volume and surgeon volume also contributed to a decrease in hospital stays, costs and mortality. Surgical treatments partial hepatectomy or lobectomy for intrahepatic cholangiocarcinoma patients had no effect on the survival rate; instead age, CCI, and high hospital volume and surgeon volume had more significant impact on a positive patient outcome.
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