The Strategy of Treatment for Mid to Distal Cholangiocarcinoma after Surgical Resection

Abstract

The overall survival (OS) rate of extrahepatic cholangiocarcinoma (ECC) remains much lower than that for other gastrointestinal malignancies. A variety of factors have been used to predict prognosis after surgical resection for ECC, but no consensus has been reached. Therefore, this study sought to identify useful prognostic factors for patients with ECC. In our institution, within the study period, 76 patients received surgical resection for mid to distal cholangiocarcinoma. Clinicopathological data were retrospectively collected, along with survival and prognosis. In multivariate analysis for OS, ductal margin status (P = 0.008) and pT category (P < 0.02) presented independent predictors of survival. In the R0 resection group, N stage and adjuvant chemotherapy presented independent predictors of recurrence in the multivariate model. The three- and five-year survival rates were significantly better in patients with negative ductal margins (77.% at three years and 63.6% at five years) than in those with positive ductal margins (33.3% at three years and 25.0% at five years) (P < 0.05). Survival rates were similar between cases of R0 resection without gemcitabine-based chemotherapy and R1 resection with gemcitabine-based chemotherapy (P = 0.6193, Log-rank test). However, survival rates between R0 resection with gemcitabine-based chemotherapy and R1 resection with gemcitabine-based chemotherapy were significantly different (P = 0.0086, Log-rank test). For good prognosis, radical resection to ensure adequate margin may be recommended for middle common bile duct cancer. In addition, regardless of margin negativity, gemcitabine-based chemotherapy is recommended for prolongation of relapse-free time and OS time.