Oncologic outcomes of preoperative therapy for distal cholangiocarcinoma

Abstract

Background: Although increasingly administered to patients with pancreatic ductal adenocarcinoma, the role of preoperative therapy for patients with distal cholangiocarcinoma is undefined. Methods: All patients with extrahepatic cholangiocarcinoma who underwent pancreatoduodenectomy at a single institution between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics and overall survival were compared between patients who underwent surgery “de novo “and those who received preoperative therapy prior to pancreatoduodenectomy. Results: Among 45 patients, 21 (46.7%) received preoperative chemotherapy (n = 5), chemoradiation (n = 10) or both (n = 6) prior to surgery while 24 (53.3%) underwent surgery first. There were no statistically significant differences in demographic, clinical, or histopathologic characteristics between the two groups. Only one patient experienced a complete pathologic response. With a median follow-up of 38.1 months, the median overall survival duration of patients who underwent surgery first was not statistically significantly different from that of patients who received preoperative therapy (50.3 vs 40.3 months p > 0.05, Figure). On multivariable cox proportional hazards analysis, only positive lymph nodes (OR 4.68 (95% CI 1.52–14.42) were associated with overall survival whereas the receipt of preoperative therapy was not (OR 1.06 (95% CI 0.42–2.66)). Conclusion: Preoperative therapy was not associated with improved outcomes among patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy. Although these data do not support the routine administration of preoperative therapy to all patients, neoadjuvant treatment sequencing represents an alternative strategy that is associated with similar long-term outcomes compared to a surgery first approach.