Abstract
The aim of the study was to calculate the short-term and long-term outcomes of curative-intent surgery in distal cholangiocarcinoma (DCC) patients to identify potential prognostic factors. A retrospective cohort study of 32 consecutive DCC patients treated with pancreaticoduodenectomy between 2009-2017. The clinicopathological and histopathological data were evaluated for prognostic factors using the univariable Cox regression analysis. The Overall Survival (OS) was estimated using the Kaplan-Meier analysis. The study comprised a total of 32 patients, with a mean age of 65.8 (± 9.0) years at the time of surgery. R0 resection was achieved in 25 (86.2%) patients, 19 (65.5%) patients received adjuvant oncological therapy. The OS rates at 1, 3 and 5 years were 62.5%, 37.5% and 21.9%, respectively. The 90-day mortality was 3/32 (9.4%) accounting for one-fourth of the first-year mortality rate. The median OS was 28.5 months. The only statistically significant prognostic factor was vascular resection, which was associated with worse OS in the univariable analysis (HR: 3.644; 95%-CI: 1.179-11.216, P=0.025). An age less than 65 years, ASA grade I/II, hospital stay of fewer than 15 days, R0 resection, lymph node ratio less than 0.2 and adjuvant oncological therapy tended to be associated with better OS but without statistically significant relevance. The main factor directly influencing the survival of DCC patients is surgical complications. Surgical mortality comprises a significant group of patients, who die in the first year following pancreaticoduodenectomy. Vascular resection is the most important negative prognostic factor for long-term survival.
Highlights
Distal cholangiocarcinoma (DCC) is a malignant disease which arises from the bile duct epithelium located in the distal part between the confluence of the cystic duct and above the Ampula of Vater and represents about 2030% of all cholangiocarcinomas[1,2,3]
Concerning the tumour-related prognostic factors, we did not verify a statistically relevant association in our study, even though the R0 resection, three or fewer positive lymph nodes, lymph node ratio (LNR) less than 0.2 and adjuvant oncological therapy tended to be associated with better Overall Survival (OS) but without statistically significant relevance
When comparing patients with 0 to 3 lymph node metastases and 4 lymph node metastases, we found an hazard ratios (HRs) of 2.072 (95%-confidence intervals (CI): 0.820-5.233, P=0.123) for this new N2 status
Summary
Distal cholangiocarcinoma (DCC) is a malignant disease which arises from the bile duct epithelium located in the distal part between the confluence of the cystic duct and above the Ampula of Vater and represents about 2030% of all cholangiocarcinomas[1,2,3]. In a group of patients treated by curatively intended surgery, the OS is significantly higher with a 5-year survival rate of 18-54% (ref.[6,7]). The aim of the study was to calculate the short-term and long-term outcomes of curative-intent surgery in distal cholangiocarcinoma (DCC) patients to identify potential prognostic factors. The only statistically significant prognostic factor was vascular resection, which was associated with worse OS in the univariable analysis (HR: 3.644; 95%-CI: 1.179-11.216, P=0.025). An age less than 65 years, ASA grade I/II, hospital stay of fewer than 15 days, R0 resection, lymph node ratio less than 0.2 and adjuvant oncological therapy tended to be associated with better OS but without statistically significant relevance. Vascular resection is the most important negative prognostic factor for long-term survival
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