Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Andrianello, Stefano; Paiella, Salvatore; Allegrini, Valentina; Ramera, Marco; Pulvirenti, Alessandra; Malleo, Giuseppe; Salvia, Roberto; Bassi, Claudio

doi:10.1007/s00423-015-1320-0

Cited by 58 publications

(52 citation statements)

References 30 publications

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“…As expected, long-term survival was still unsatisfactory; nevertheless, our finding of a 5-year OS rate of 48.1% was comparable or slightly better than the results of previously reported studies [2-5,7,11]. Tumor differentiation and LN metastases were identified as important predictors of survival in our study, as demonstrated in other studies [2-5,7,12].…”

Section: Discussionsupporting

confidence: 85%

“…Although there have been considerable advancements in surgical management and multidisciplinary approaches, its aggressive nature has not been changed. Despite curative resection, which is typically pancreaticoduodenectomy (PD) for distal EHBD, more than half of patients can experience recurrence pancreaticoduodenectomy, leading to poor overall 5-year survival rates ranging from 20% to 50% [2-7]. Because there have been no randomized trials, adjuvant strategies for EHBD cancer following resection have been controversial, particularly with respect to the application of postoperative radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the prognostic factors for these rare tumors have not been widely established because they only comprise about 30% of EHBD cancer occurrences [9,10]. Many previous studies showed weakness in heterogeneous treatments and insufficient follow-up duration [2-7]. Therefore, we evaluated the long-term outcome of patients undergoing PD followed by adjuvant CRT for DCC in a high-volume center to identify the prognostic impact of clinicopathological factors.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Kim

Chie

et al. 2017

Cancer Res Treat

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PurposeThis study was conducted to evaluate the long-term outcome in patients undergoing pancreaticoduodenectomy (PD) followed by adjuvant chemoradiotherapy for distal cholangiocarcinoma (DCC) in a high-volume center and to identify the prognostic impact of clinicopathologic factors.Materials and MethodsA total of 132 consecutive patients who met the inclusion criteria were retrieved from the institutional database from January 1995 to September 2009. All patients received adjuvant treatments at a median of 45 days after the surgery. Median follow-up duration was 57 months (range, 6 to 225 months) for all patients and 105 months for survivors (range, 13 to 225 months).ResultsThe 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 70.7%, 55.7%, 49.4%, and 48.1%, respectively. Univariate analysis revealed poorly differentiated (P/D) tumors and lymph node (LN) metastasis were significantly associated with DMFS and OS. Additionally, preoperative carbohydrate antigen 19-9 level was significantly correlated with DFS, LRRFS, and DMFS. Upon multivariate analysis for OS, P/D tumors (p=0.015) and LN metastasis (p=0.003) were significant prognosticators that predicted inferior OS. Grade 3 or higher late gastrointestinal toxicity occurred in only one patient (0.8%).ConclusionAdjuvant chemoradiotherapy after PD for DCC is an effective and tolerable strategy without significant side effects. During long-term follow-up, we found that prognosis of DCC was mainly influenced by histologic differentiation and LN metastasis. For patients with these risk factors, further research should focus on improving adjuvant strategies as well as other treatment approaches.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Kim

Chie

et al. 2017

Cancer Res Treat

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“…However, the incidence of bile duct cancer is increasing, along with the increase in average age [17] . Many previous reports have focused on the clinicopathological factors associated with distal cholangiocarcinoma [8,17,18] . However, nearly all of those factors could only be determined postoperatively; as a result, the preoperative prognostic factors associated with these tumors remained unknown.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors Associated with Preoperative Clinicophysiological Outcomes of Distal Cholangiocarcinoma

Suzuki

Kajiyama²,

Shimoda³

et al. 2017

Dig Surg

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Background/Aims: Although biliary tract cancer is generally associated with a high mortality rate, patients with distal cholangiocarcinoma have better prognoses, compared to those with periampullary cancer. This study aimed to determine the preoperative clinicophysiological factors predictive of survival and recurrence in patients with distal cholangiocarcinoma. Methods: Forty-five patients (34 men) with distal cholangiocarcinoma who underwent pancreaticoduodenectomy between 2005 and 2013 were examined retrospectively at our center and associated hospitals. Clinicophysiological parameters included predictors of overall survival (OS). Kaplan-Meier survival curves were generated and compared using log-rank tests, and Cox proportional hazard multivariate analyses were performed. Results: The mean patient age was 68.8 years (range 54-81 years). Patients had a median OS duration of 43 months, and 1-, 3-, and 5-year OS rates of 91.1, 61.1, and 40.4%, respectively. Univariate analyses indicated that the body mass index, C-reactive protein (CRP) level, and carcinoembryonic antigen level were independent prognostic factors for OS; however, only the CRP level remained an independent prognostic factor in a multivariate analysis. Conclusions: A CRP level <0.3 mg/dL was predictive of a better outcome among patients with distal cholangiocarcinoma.

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“…61 PD with lymphadenectomy remains the procedure of choice to obtain cancerfree surgical margins and to harvest enough lymph nodes for staging. 62 Without resec tion, the 5year survival is less than 10%. If resected, 5year survival is 23%-33%.…”

Section: Cholangiocarcinomamentioning

confidence: 99%

Whipple procedure: patient selection and special considerations

Tan-Tam¹,

Segedi²,

Chung³

2016

OAS

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At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improve ments in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery, thereby also putting emphasis on operative patient selection to minimize complica tions. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well.

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Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Cited by 58 publications

References 30 publications

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Prognostic Factors Associated with Preoperative Clinicophysiological Outcomes of Distal Cholangiocarcinoma

Whipple procedure: patient selection and special considerations

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