Relevant prognostic factors influencing outcome of patients after surgical resection of distal cholangiocarcinoma

Oliver Beetz,Florian W R Vondran,Sebastian Cammann,Harald Schrem,Moritz Kleine,Jürgen Klempnauer,Jill Gwiasda,Felix Oldhafer,Karl J Oldhafer,Michael Klein

doi:10.1186/s12893-018-0384-5

Oliver Beetz, Florian W R Vondran + Show 8 more

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https://doi.org/10.1186/s12893-018-0384-5

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Abstract

BackgroundDistal cholangiocarcinoma (DCC) is a rare but over the last decade increasing malignancy and is associated with poor prognosis. According to the present knowledge curative surgery is the only chance for long term survival. This study was performed to evaluate prognostic factors for the outcome of patients undergoing curative surgery for distal cholangiocarcinoma.Methods75 patients who underwent surgery between January 2000 and December 2014 for DCC in curative intention were analysed retrospectively. Potential prognostic factors for survival were investigated including the extent of surgery using purposeful selection of covariates in multivariable Cox regression modeling.ResultsPreoperative biliary stenting (Hazard ratio (HR): 2.530; 95%-CI: 1.146–6.464, p = 0.020), the extent of surgery in case of positive histological venous invasion (HR: 1.209; 95%-CI: 1.017–1.410, p = 0.032), lymph node staging (HR: 2.183; 95%-CI: 1.250–3.841, p = 0.006), perineural invasion (HR: 2.118; 95%-CI: 1.147–4.054, p = 0.016) and postoperative complications graded in points according to Clavien-Dindo (HR: 1.395; 95%-CI: 1.148–1.699, p = 0.001) were indentified as independent significant risk factors for survival. Patients receiving preoperative biliary stenting showed prolonged duration between onset of symptoms and date of operation (p = 0.048).ConclusionsPreoperative biliary stenting reduces survival possibly due to delayed surgery. The extent of surgery is not an independent risk factor for survival except for patients with concomitant histological venous invasion. Oncological factors and postoperative surgical complications are independent prognostic factors for survival.

Highlights

Distal cholangiocarcinoma (DCC) is a rare but over the last decade increasing malignancy and is associated with poor prognosis
Location of the tumor was primarily defined by endoscopic retrograde cholangiopancreatography (ERCP)
The extent of tumor was anticipated mainly according to computed tomography (CT), CT scans could not identify any tumor mass in 22 patients

Summary

Introduction

Distal cholangiocarcinoma (DCC) is a rare but over the last decade increasing malignancy and is associated with poor prognosis. According to the present knowledge curative surgery is the only chance for long term survival. This study was performed to evaluate prognostic factors for the outcome of patients undergoing curative surgery for distal cholangiocarcinoma. The primary location of the carcinoma in reference to the biliary tract influences clinical manifestation and therapy. They are classified into intrahepatic, proximal extrahepatic and distal extrahepatic cholangiocarcinomas (DCC) [2]. Curative surgery is the only chance for long-term survival [3,4,5,6,7,8,9]. Palliative chemotherapy can achieve median survival rates of 8.1 to 11.7 months [10]

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