Distal Bile Duct Carcinoma Research Articles

Thioredoxin System Protein Expression in Carcinomas of the Pancreas, Distal Bile Duct, and Ampulla in the United Kingdom.

Background: Poor survival outcomes in periampullary cancer highlight the need for improvement in biomarkers and the development of novel therapies. Redox proteins, including the thioredoxin system, play vital roles in cellular antioxidant systems. Methods: In this retrospective study, thioredoxin (Trx), thioredoxin-interacting protein (TxNIP), and thioredoxin reductase (TrxR) protein expression was assessed in 85 patients with pancreatic ductal adenocarcinoma (PDAC) and 145 patients with distal bile duct or ampullary carcinoma using conventional immunohistochemistry. Results: In patients with PDAC, high cytoplasmic TrxR expression was significantly associated with lymph node metastasis (p = 0.033). High cytoplasmic and nuclear Trx expression was significantly associated with better overall survival (p = 0.018 and p = 0.006, respectively), and nuclear Trx expression remained significant in multivariate Cox regression analysis (p < 0.0001). In distal bile duct and ampullary carcinomas, high nuclear TrxR expression was associated with vascular (p = 0.001) and perineural (p = 0.021) invasion, and low cytoplasmic TxNIP expression was associated with perineural invasion (p = 0.025). High cytoplasmic TxNIP expression was significantly associated with better overall survival (p = 0.0002), which remained significant in multivariate Cox regression analysis (p = 0.013). Conclusions: These findings demonstrate the prognostic importance of Trx system protein expression in periampullary cancers.

Prognostic Significance of Intratumoral and Peritumoral Budding in Distal Extrahepatic Bile Duct Carcinoma

Introduction: Although tumor budding (TB) has been recognized as a representative adverse prognosticator in gastrointestinal malignancies, it is not well elucidated in distal extrahepatic bile duct carcinoma (DBDC). Herein, we investigated the prognostic significance of peritumoral (PTB) and intratumoral (ITB) budding according to the modified DBDC staging of the 8th edition of the American Joint Committee on Cancer. Methods: PTB and ITB were independently evaluated in a cohort of DBDC patients (n = 410) based on the 2016 International Tumor Budding Consensus Conference. Results: High levels of PTB (PTBHigh, ≥ grade-2) and ITB (ITBHigh, ≥ grade-3) were identified in 316 (77%) and 238 (58%) cases, respectively. In univariate analysis, PTBHigh and ITBHigh, larger size and sclerosing tumor growth pattern, higher histologic grade, extrapancreatic location, adenocarcinomas unrelated to intraductal papillary neoplasm of the bile duct, pancreatic, duodenal, and lymphovascular invasion, perineural invasion, cancer involvement of the bile duct resection margin, nodal metastasis, and higher T and N categories and disease stages were associated with shorter patient overall survival (OS) times. In multivariate analysis, PTBHigh and ITBHigh remained poor independent prognostic indicators of OS in DBDC patients. Specifically, ITBHigh could predict poor prognosis in patients with stage I (T1N0) DBDC. Conclusions: Both PTBHigh and ITBHigh were strong prognostic indicators in patients with DBDC. Thus, ITB could be used to predict worse prognoses in patients with DBDC, in which PTB is difficult to assess, especially for patients with stage I (T1N0) DBDC.

127P Prognostic significance of intratumoral and peritumoral budding in distal extrahepatic bile duct carcinoma

127P Prognostic significance of intratumoral and peritumoral budding in distal extrahepatic bile duct carcinoma

Prognostic Factors for Distal Bile Duct Carcinoma After Surgery.

Distal bile duct carcinoma continues to be one of the most difficult cancers to manage in terms of staging and radical resection. Pancreaticoduodenectomy (PD) with regional lymph node dissection has become the standard treatment of distal bile duct carcinoma. We evaluated treatment outcomes and histological factors in patients with distal bile duct carcinoma. Seventy-four cases of resection of carcinoma of the distal bile ducts treated at our department during the period from January 2002 and December 2016 using PD and regional lymph node dissection as the standard surgical procedure were investigated. Survival rates of factors were analyzed using uni- and multivariate analyses. The median survival time was 47.8 months. On univariate analysis, age of 70 years or older, histologically pap, pPanc2,3, pN1, pEM0, v2,3, ly2,3, ne2,3 and postoperative adjuvant chemotherapy were statistically significant factors. On multivariate analysis, histologically pap was identified as a significant independent prognostic factor. The multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as showing a significant trend towards independent prognostic relevance. The good news about resected distal bile duct carcinoma is that the percentage of those who achieved R0 resection has risen to 89.1%. Our multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as prognostic factors. In order to improve the outcome of treatment, it is necessary to improve preoperative diagnostic imaging of pancreatic invasion and lymph node metastasis, establish the optimal operation range and clarify whether aortic lymph node dissection is needed to control lymph node metastasis, and establish effective regimens of chemotherapy.

Middle and distal bile duct carcinoma, retrospective analysis & short-term and long-term outcomes of surgical therapy.

The prognosis of extrahepatic cholangiocarcinoma is dismal and the only way to achieve long-term survival is surgical resection. While pancreatoduodenectomy (PD) is the standard procedure for distal cholangiocarcinoma (distal bile duct cancer; DBDC), bile duct segmental resection (BDR) can be used as an alternative approach for middle bile duct cholangiocarcinoma (middle bile duct cancer; MBDC). The aim of the study was to calculate the short-term and long-term outcomes of curative-intent surgery in distal bile duct cholangiocarcinoma patients. A retrospective cohort study of consecutive patients treated for MBDC and DBDC with PD or BDR between 1/2009-12/2019. The patients were divided according to the type of surgical resection (PD and BDR group). Demographic, clinicopathological and histopathological data and overall survival (OS) were evaluated in both groups. OS was estimated using the Kaplan-Meier analysis. The study comprised a total of 62 patients - 45 patients (72.6%) in the PD group and 17 (27.4%) in the BDR group. Patients undergoing BDR were significantly older than those receiving PD (p=0.048). Men predominated in the PD group (N=34/45; 75.6%) while more women were included in the BDR group (N=10/17; 58.8%). Median age was higher in the BDR group (p=0.048). Serious morbidity (Clavien-Dindo III-V) (33.3% vs 11.8%), 30-day and 90-day mortality (4.4% vs 0.0% and 8.9% vs 5.9%, respectively) predominated in the PD group although the differences were not statistically significant, as well as a longer hospital stay (16.0 days vs 11.0 days; p=0.002). Pathological assessments revealed comparable numbers of positive lymph nodes in both groups, but a significantly higher number of total resected lymph nodes in the PD group (p.

The T Category of Distal Extrahepatic Bile Duct Carcinoma: A Comparative Analysis With Invasive Tumor Thickness.

The T category of distal extrahepatic bile duct carcinoma (DBDC) is based on invasion depth from the basal lamina to the deepest infiltrating tumor cells. Recently, invasive tumor thickness (ITT) was proposed, defined as maximal vertical distance of invasive tumor components regardless of the basal lamina. We compared the predictive value of T category, and ITT grading in 424 surgically resected DBDCs. DBDCs were categorized as 6 Tis (1.4%), 134 T1 (<5 mm; 31.6%), 204 T2 (5 to 12 mm; 48.1%), and 80 T3 (>12 mm; 18.9%). With ITT, there were 6 G0 (no invasion; 1.4%), 3 G1 (<1 mm; 0.7%), 90 G2 (≥1 and <5 mm; 21.2%), 188 G3 (≥5 and <10 mm; 44.4%), and 137 G4 (≥10 mm; 32.3%). The 5-year survival rates of T1, T2, and T3 were 58.9%, 44.2%, and 18.2%, and those of ITT G1, G2, G3, and G4 were 33.3%, 54.1%, 51.6%, and 26.7%, respectively. The T category discriminated patient survival by overall (P<0.001) and pairwise (T1 vs. T2, P=0.007; T2 vs. T3, P<0.001) comparisons. ITT grading distinguished survival by overall and between G3-G4 (both P<0.001), with no survival differences observed between G1-G2 and G2-G3 comparisons. The T category more accurately discriminated patient survival than ITT grading. To determine the T category for DBDCs, (1) longitudinal sectioning on gross examination, especially for DBDCs with large papillary or nodular growth patterns; (2) evaluation of serial sections or alternative hematoxylin and eosin slides; (3) use of a straight or curved baseline depending on the shape of the peritumoral normal bile duct wall and/or the basal lamina of the peritumoral normal biliary epithelia/biliary intraepithelial neoplasias are recommended.

Surgical resection of mixed neuroendocrine-non-neuroendocrine neoplasm in the biliary system: a report of two cases

BackgroundMixed neuroendocrine-non-neuroendocrine neoplasm (MINEN) is a rare disease and there is scarce literature on its diagnosis, treatment, and prognosis. We encountered two unusual cases of MINEN in the biliary tract, one in the ampulla of Vater and the other in the distal bile duct. In this report, we describe the clinical course of these two cases in detail.Case presentationCase 1: A 69-year-old woman presented with a chief complaint of epigastric pain. When endoscopic sphincterotomy and retrograde biliary drainage were performed for gallstone pancreatitis, an ulcerated lesion was found in the ampulla of the Vater. Based on the biopsy results, the lesion was diagnosed as the ampulla of Vater carcinoma and subtotal stomach-preserving pancreatoduodenectomy (SSPPD) was performed. Postoperative histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, consistent with the diagnosis of MINEN. In addition, lymph node metastasis was found on the dorsal side of the pancreas and the metastatic component was adenocarcinoma. Adjuvant chemotherapy with etoposide and cisplatin was administered for 6 months, and presently the patient is alive without recurrence 64 months after surgery. Case 2: A 79-year-old man presented with a chief complaint of anorexia. Cholangiography showed severe stenosis of the distal bile duct. A biopsy was conducted from the stenotic lesion and it revealed the lesion to be adenocarcinoma. A diagnosis of distal bile duct carcinoma was made, and SSPPD was performed. Histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, and the tumor was confirmed as MINEN of the distal bile duct. No adjuvant chemotherapy was administered due to the poor performance status. 7 months later, the patient was found to have a liver metastasis.ConclusionWe experienced two valuable cases of biliary MINEN. To identify better treatments, it is important to consider the diversity of individual cases and to continue sharing a variety of cases with different presentations.

Hybrid laparoscopic pancreaticoduodenectomy: Ukrainian single center experience

Background: Minimally invasive pancreaticoduodenectomy both laparoscopic and robotic is becoming a new standart of operative management in patients with distal bile duct carcinoma, periampullary adenocarcinoma, pancreas head cancer, and duodenal cancer worldwide. It shows lot of advantages for patients but the same time stays quite challenging for surgeons performing it. However, there are significant limitations to the successful implementation of minimally invasive pancreaticoduodenectomies in developing countries, including Ukraine.

Polyclonal PAX8 expression in carcinomas of the biliary tract — Frequent non-specific staining represents a potential diagnostic pitfall

Paired box protein 8 (PAX8) is a transcription factor that is considered a relatively specific marker of carcinomas of the thyroid, kidney, and Müllerian/Wolffian duct derivatives. Unexpected PAX8 immunoreactivity has occasionally been reported in other tumors. The frequency of PAX8 expression in carcinomas of the biliary tract is not well studied. We evaluated the immunohistochemical expression of PAX8 in 73 cases of biliary tract carcinoma. We found that 28 of 73 (38%) biliary tract carcinomas had variable immunoreactivity for PAX8, assessed by a widely used polyclonal antibody (ProteinTech Group, Chicago, IL). This included 3 (4%) of cases with strong diffuse, and 14 (19%) of cases with strong focal staining. Strong PAX8 expression was more frequent in distal bile duct carcinomas than other biliary sites (p = 0.015), and showed a weak association with advanced T stage (T3-T4 versus T1-T2; p = 0.09). No correlation was observed between PAX8 positivity and age at diagnosis, gender, or lymph node metastasis. The 28 polyclonal PAX8-positive cases were largely negative for monoclonal PAX8 and PAX6 immunostains, with only rare tumor cells with weak immunoreactivity being present in a subset of cases. We show that a substantial fraction of biliary tract carcinomas exhibit immunoreactivity with a widely used polyclonal PAX8 antibody. Pathologists should be aware of this potential pitfall during the diagnostic workup of hepatobiliary lesions to avoid misdiagnosis as a metastasis from a PAX8-positive tumor.

遠位胆管癌術後に膵腺扁平上皮癌と浸潤性膵管癌を併発した同時性残膵癌の1例

遠位胆管癌術後に膵腺扁平上皮癌と浸潤性膵管癌を併発した同時性残膵癌の1例

Different role of MSLN and CA125 co-expression as a prognostic predictor between perihilar and distal bile duct carcinoma.

Recent studies have suggested that the interaction of mesothelin (MSLN) and cancer antigen 125 (CA125) enhances tumor metastases. The aim of the present study was to clarify the impact of MSLN and CA125 co-expression on the prognosis of patients with extrahepatic bile duct carcinoma (BDC). Tissue samples from patients who underwent surgical resection between 2007 and 2015 for perihilar or distal BDC were immunohistochemically examined. The expression levels of MSLN and CA125 in tumor cells were analyzed. The expression in <50% and ≥50% of the total tumor cells were defined as low- and high-level expression, respectively. Tissue samples were obtained from 31 patients with perihilar BDC and 43 patients with distal BDC. Lymph node metastases were associated with MSLN and CA125 co-expression in patients with perihilar BDC (P=0.002), while there was no association between lymph node metastasis and co-expression in patients with distal BDC (P=0.362). MSLN and CA125 co-expression was associated with a worse overall survival rate in patients with perihilar BDC (5-year overall survival rate, co-expression positive vs. negative, 24 vs. 63%; P=0.038). To the best of our knowledge, the present study is the first to report an association between co-expression of MSLN and CA125 with a poor prognosis in patients with perihilar BDC. The current findings suggested that the significance of co-expression differed according to the BDC location.

Tumor Infiltration Was Associated with Postoperative Survival Rate in Distal Bile Duct Carcinoma

Background: The distal bile duct carcinoma is usually in the advanced stage at the time of diagnosis. Although surgical resection is a golden standard of the treatment, the recurrence rate is still high resulting in a poor prognosis. In this study, we retrospectively reviewed our experiences of resected cases of distal bile duct carcinoma, in terms of clinicopathological features and the outcome. Materials and Methods: Between April 2000 and October 2019, pancreatoduodenectomy (PD) was performed for 109 cases of distal bile duct carcinoma at our department. Of these, 86 cases underwent non-residual tumor surgery (R0). Results: There were 61 males and 25 females with a median age of 69.0 years. The median operation time was 503.5 min and the median operative blood loss was 696.5 ml. The overall 5-year survival rate (5-SR) was 47.4 %. Pathological examination revealed that there were 9 cases of UICC stage I, 53 cases of stage IIA, 22 cases of stage IIB, and 2 cases of stage IIIA. Each stage revealed no significant difference in 5-SR. Clinicopathological findings revealed no significant differences in 5-SR between patients with those positive or negative for tumor size, lymphatic invasion, vein invasion, and lymph node metastasis. However, tumor infiltration positive cases were associated with poor prognosis (P=0.028). The results revealed that tumor infiltration was associated with postoperative mortality (odds ratio, 2.024; 95% CI, 1.061-3.859; P= 0.032). Conclusions: Tumor infiltration was associated with postoperative survival rate in distal bile duct carcinoma.

Surgery for Recurrent Biliary Carcinoma: Results for 5 Recurrent Cases

Introduction: Typically chemotherapy has been used as standard treatment and surgeries were rarely performed for recurrent extrahepatic biliary carcinoma (RBC). Thus whether surgery for RBC is feasible has remained unclear. Methods: From 2013 to 2019, 5 patients underwent radical resection for RBC at our institution. We retrospectively reviewed the medical data. Results: Recurrence sites were liver metastasis in 3 patients (LM group) and local or bile duct recurrence in 2 patients (BD group). In the LM group, the underlying pathology was distal bile duct carcinoma, gallbladder carcinoma and ampullary carcinoma. Limited resections of the liver were performed for all 3 patients in the LM group. There was no morbidity nor mortality. 1 patient with liver metastasis of gallbladder carcinoma survived 6 years after surgery for RBC. The other 2 patients had recurrence at 9 and 14 months after surgery. In the BD group, the underlying pathology was distal bile duct carcinoma and proximal bile duct carcinoma. 1 patient underwent pancreaticoduodenectomy in the primary surgery and extended right hemihepatectomy for RBC. The other underwent central bisegmentectomy of the liver in the primary surgery and right lateral sectionectomy of the liver for RBC. There was morbidity in 1 patient but no mortality. Both patients could achieve curative resection and survive without recurrence for 9 and 2 months after surgery for RBC. Conclusion: Surgery for RBC is technically demanding procedure but appears feasible and have a possibility of offering longer survival for selected patients but we should be cautious of indication.

Abstract 3627: Comparison of genetic profiles of small and large duct type intrahepatic cholangiocarcinoma with distal extrahepatic cholangiocarcinoma

Abstract Cholangiocarcinoma comprises epithelial malignancy that occurs in various sites in the biliary tree. Cholangiocarcinoma is categorized into intrahepatic, perihilar, and distal bile duct carcinomas according to its anatomical position. According to the fifth edition of World Health Organization Classification of Tumors, intrahepatic cholangiocarcinoma (ICC) is further classified into small- and large duct types on histopathological basis. We analyzed molecular profiles of different types of cholangiocarcinoma by next-generation sequencing (NGS). We utilized the Oncomine Comprehensive Assay (OCA) panel v2 on the IonTorrent™ NGS platform to explore genetic differences among the two histologic types of ICC and distal extrahepatic cholangiocarcinoma (DEC). Formalin-fixed paraffin-embedded tumor tissues were obtained from 25 patients who underwent surgical resection of cholangiocarcinoma in Korea University Guro Hospital between 2010 and 2018. We analyzed 7 and 8 small- and large duct type ICCs and 10 DECs. NGS assay of the included cases showed distinct genetic alterations between ICC and DEC, which were enriched in different biological pathways. Unsupervised hierarchical clustering analysis showed two distinct groups. The first group consisted of 12 cases (9 DECs and 3 large duct type ICCs). The second group included 13 cases (7 large duct type and 6 small duct type ICCs). Molecular alteration patterns of a subset of large duct type ICCs were more closely related to DECs than small duct type ICCs. All included small duct type ICCs were considered genetically distinct from DECs. Our study suggested an association between anatomical and histopathological classifications of intra- and extrahepatic cholangiocarcinomas. Citation Format: Hayeon Kim, Soo Yeon Lee, Aeree Kim, Baek-hui Kim, Chung-yeul Kim. Comparison of genetic profiles of small and large duct type intrahepatic cholangiocarcinoma with distal extrahepatic cholangiocarcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3627.

Recurrence of Distal Bile Duct Carcinoma on Percutaneous Transhepatic Biliary Drainage Fistula and Lymph Node of the Right Axilla

Recurrence of Distal Bile Duct Carcinoma on Percutaneous Transhepatic Biliary Drainage Fistula and Lymph Node of the Right Axilla

Clinicopathologic and Prognostic Significance of Gallbladder and Cystic Duct Invasion in Distal Bile Duct Carcinoma.

The roles of the gallbladder and cystic duct (CD) invasions in distal bile duct carcinoma (DBDC) have not been well elucidated. To define the characteristics and prognostic significance of gallbladder or CD invasions in patients with DBDC. Organ invasion patterns with clinicopathologic features were assessed in 258 resected DBDCs. CD invasions (N = 31) were associated with frequent concomitant pancreatic and/or duodenal invasions (23 of 31, 74%) and showed stromal infiltration (16 of 31, 52%) and intraductal cancerization (15 of 31, 48%) patterns. In only 2 cases, invasions with intraductal cancerization were observed in the gallbladder neck. Conversely, all pancreatic (N = 175) and duodenal (83) invasions developed through stromal infiltration. CD invasions were associated with larger tumor size (P = .001), bile duct margin positivity (P = .001), perineural invasions (P = .04), and higher N categories (P = .007). Patients with pancreatic or duodenal invasions had significantly lower survival rates than those without pancreatic (median, 31.0 versus 93.9 months) or duodenal (27.5 versus 56.8 months, P < .001, both) invasions. However, those with gallbladder or CD invasions did not have different survival times (P = .13). Patients with concomitant gallbladder/CD and pancreatic/duodenal invasions demonstrated significantly lower survival rates than those without organ invasions (P < .001). Gallbladder invasions were rare in DBDCs as neck invasions with intraductal cancerization. CD invasions occurred by stromal infiltrations and intraductal cancerization, whereas all pancreatic and duodenal invasions had stromal infiltration patterns. Gallbladder and/or CD invasions did not affect survival rates of patients with DBDC, while pancreatic and duodenal invasions affected survival rates. Therefore, these differences in survival rates may originate from the different invasive patterns of DBDCs.

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

PurposeTo investigate the risk factors for post-pancreatectomy hemorrhage (PPH).MethodsThe incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy.ResultsThe incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0–2 (2%) and 3–4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy.ConclusionOur study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes “absence of DM” for predicting PPH.

Clinical efficacy of laparoscopic modified loop cholecystojejunostomy for the treatment of malignant obstructive jaundice

ObjectiveThis study was performed to summarize our experience and investigate the safety and efficacy of laparoscopic modified loop cholecystojejunostomy for the treatment of malignant obstructive jaundice.MethodsThirteen patients with malignant obstructive jaundice who underwent laparoscopic modified loop cholecystojejunostomy from March 2015 to March 2016 were retrospectively reviewed. The patients’ characteristics, operation time, postoperative intestinal recovery time, length of hospital stay, postoperative bilirubin level, and complications were analyzed.ResultsThe patients were followed up as outpatients for 2 years. Nine patients with pancreatic head carcinoma, one patient with periampullary carcinoma, and three patients with distal bile duct carcinoma successfully underwent laparoscopic modified loop cholecystojejunostomy. The mean operation time was 176 ± 45 minutes, and the mean length of hospital stay was 9.5 ± 2.8 days. The serum total bilirubin concentration and gamma-glutamyl transferase concentration significantly decreased on postoperative day 7. The median follow-up time was 7 months. No patients developed bile leakage or required a reoperation.ConclusionsLaparoscopic modified loop cholecystojejunostomy is not only safe and minimally invasive, but it is also feasible for patients with malignant obstructive jaundice.

Impact of preoperative Body Mass Index on postoperative outcome and long-term survival in 1,675 patients undergoing pancreatic resections for underlying malignancy

Introduction: Pancreatic resections may nowadays be performed safely. However, individual prognostic markers may still be associated with an increased risk for postoperative morbidity and mortality. The aim of our study was to analyze the impact of Body Mass Index (BMI) in patients undergoing pancreatic resections for underlying malignancy with regard to postoperative outcome and overall survival. Patients and methods: BMI and relevant postoperative parameters of 1,675 patients who underwent pancreatic resections at our institution were analyzed. Indications for pancreatic resections included pancreatic adenocarcinoma in 1,209 patients (72.2%), papillary carcinoma in 200 patients (11.9%), distal bile duct carcinoma in 235 patients (14.0%) and duodenal carcinoma in 31 patients (1.9%). Patients were classified into four groups according to their BMI (kg/m2 ) (Group A < 20, Group B, 20-25, Group C 25–30, Group D >30). Results: A total of 1,360 pancreatic head resections (81.2%), 179 distal pancreatectomies (10.7%), 131 total pancreatectomies (9.6%) and 5 other resections (0.1%) were performed. Overall 30-day mortality was 3.1%. There were significant differences in postoperative complications > Clavien II (group A, 18.6%; group B, 22.5%; group C, 28.4%, group D, 39,7%) as well in length of hospital stay, reoperation rate and overall survival between the different groups. Conclusion: The results of our study demonstrate that preoperative BMI is a prognostic relevant parameter for postoperative outcome and overall survival in patients undergoing pancreatic resections. Especially patients in BMI-group D are at increased risk for postoperative complications and have to be carefully evaluated for surgical therapy.

PO-241 Prognostic factors for operable biliary tract cancer: serum levels of lactate dehydrogenase: a strong association with survival

IntroductionBiliary tract cancers (BTCs) are uncommon but fatal. In the United States in 2017, the estimated numbers of new cancer cases from gallbladder and other biliary tissue was 11 740 (5,320 in males; 6420 in females) and the estimated number of deaths was 3830 (1,630 in males; 2200 in females). Tumours of the biliary tract typically have a poor prognosis, with 5 year survival rates in the range of 5%–15%. BTCs encompass gallbladder carcinoma (GBC), distal bile duct (DBD), intrahepatic (IHC), and hilar cholangiocarcinoma. This study was designed to investigate the prognostic factors for operable BTC.Material and methodsBaseline demographics at diagnosis were retrospectively evaluated in 341 BTC patients undergoing radical surgery at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2015. The association between prognostic factors and overall survival (OS) was determined by multivariate analysis using the Cox proportional hazards regression model.Results and discussionsOur study showed that 341 patients were included in the analysis, of which 166 (48.7%) were male and 175 (51.3%) were female. Older age, depth of tumour invasion, positive surgical margin, lower haemoglobin, and higher lactic dehydrogenase (LDH) were associated with significantly worse OS using multivariate analysis. In the entire cohort, the estimate of median OS in patients with LDH<271 U/L was 36.291 months (95% confidence interval (CI); 30.989–41.594 months), and 30.736 months (95% CI; 19.154–42.318 months) in patients with LDH≥271 U/L (adjusted hazard ratio (HR)−1.505, 95% CI; 1.009–2.245, p=0.045). Moreover, it was investigated whether serum LDH retained its significance as a prognostic marker in BTC subgroups separately. The results showed that LDH was prognostic in patients with distal bile duct (DBD) carcinoma undergoing radical surgery (HR-2.452, 95% CI; 1.167–5.152, p=0.018). However, there were no statistical differences between LDH and OS in multivariate analysis in the other three individual subgroups except for DBD. This may be due to the limited number of patients in the study, indicating that a greater number of patients may be required for statistical significance.ConclusionOlder age, depth of tumour invasion, positive surgical margin status, lower haemoglobin levels, and elevated serum LDH level are associated with poor survival in operable BTC patients. Serum LDH level is a cost-effective prognostic biomarker in patients with operable BTC and especially DBD carcinoma.