# Facility Type Predicts Completeness of Oncologic Resection and Survival in Biliary Tract Cancers

## TL;DR

Academic hospitals perform better oncologic surgeries for biliary tract cancers, leading to better patient survival.

## Contribution

The study shows facility type and cancer subtype affect surgical quality and survival in biliary tract cancers.

## Key findings

- Academic centers achieved higher rates of adequate lymphadenectomy compared to non-academic centers.
- Gallbladder cancer had the lowest odds of achieving complete oncologic resection components.
- Non-academic facilities were associated with higher mortality rates for BTC patients.

## Abstract

Complete Oncologic Resection (COR) for biliary tract cancers (BTC) includes negative margin status and adequate lymphadenectomy, defined as retrieval of ≥ 6 lymph nodes. Whether these standards and their association with survival vary across facility types and BTC subtypes remains unclear.

Using the National Cancer Database (2004–2022), we identified adults undergoing curative-intent resection for Stage I-III BTC, excluding T1a gallbladder cancer. Facility types were compared for COR using nested logistic regression, adjusting for demographic and tumor factors. Overall survival (OS) was assessed using multivariable Cox proportional hazards models, with Kaplan-Meier (KM) analyses used to describe unadjusted, stratified survival patterns.

Among 13,250 adults, 51.6% were treated at academic centers. Negative margins were achieved in 79.5% of academic versus 79.0% elsewhere, while adequate lymphadenectomy occurred in 48.2% versus 38.2%, respectively (p < 0.001). Non-academic programs had lower odds of COR (OR 0.78–0.94), and gallbladder cancer had the lowest odds of each COR component relative to other BTC subtypes (negative margins: OR 0.80, 95% CI 0.69–0.93; adequate lymphadenectomy: OR 0.77, 95% CI 0.68–0.88). Cox estimates showed higher mortality with positive margins (HR 1.80, 95% CI 1.71–1.89), inadequate lymphadenectomy (HR 1.22, 95% CI 1.16–1.28), incomplete oncologic surgery (HR 1.36, 95% CI 1.30–1.43), and non-academic facilities (HR 1.17, 95% CI 1.12–1.23).

Academic centers more frequently deliver COR and are associated with improved survival, but lymphadenectomy benchmarks remain unmet across facility types. System-level interventions, including multidisciplinary collaboration and referral networks, are necessary to expand access to high-quality care and improve outcomes.

The online version contains supplementary material available at 10.1007/s12029-026-01421-1.