Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma

Byrling, Johannes; Andersson, Roland; Sasor, Agata; Lindell, Gert; Ansari, Daniel; Nilsson, Johan; Andersson, Bodil

doi:10.20524/aog.2017.0169

Cited by 14 publications

(16 citation statements)

References 48 publications

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“…Our study revealed a local recurrence rate of 11% after dCCA resection, which is lower than the previously reported rates of 14%–24% (12, 15). It is easier to achieve clear resection margins in patients with dCCA because, in contrast to pCCA, the anatomical structures around the tumor can usually be resected.…”

Section: Discussioncontrasting

confidence: 84%

“…In several earlier studies, lymph node metastases were the most widely reported prognostic factor for dCCA (12–16) and that tumor grade and CA19-9 levels were the most common prognostic factors for pCCA (17, 18). Although R0 resection is an important prognostic factor for pancreatic ductal adenocarcinoma, it appears to have a smaller role in CCA.…”

Section: Discussionmentioning

confidence: 93%

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Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal Cholangiocarcinomas

et al. 2019

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Background: Perihilar cholangiocarcinoma and distal cholangiocarcinoma arise from the same tissue but require different surgical treatment methods. It remains unclear whether these cholangiocarcinoma types have different outcomes, prognostic factors, and/or recurrence patterns. Methods: This retrospective study evaluated patients who underwent curative-intent resection for perihilar cholangiocarcinoma or distal cholangiocarcinoma at a tertiary academic hospital during 2000–2015. Survival and prognostic factors were identified using Kaplan–Meier and Cox regression analyses. Results: The 90-day mortality rates were 0% for perihilar cholangiocarcinoma (36 patients) and 4% for distal cholangiocarcinoma (47 patients). There were no significant differences between perihilar cholangiocarcinoma or distal cholangiocarcinoma in median overall survival (30.9 vs 40.4 months) or median disease-free survival (14.2 vs 21.4 months). Among perihilar cholangiocarcinoma patients, age > 65 years was an independent predictor of poorer overall survival (hazard ratio: 2.45, 95% confidence interval: 1.07–5.64), while requiring bile duct re-resection was an independent predictor of disease-free survival (hazard ratio: 2.76, 95% confidence interval: 1.01–7.51). Among distal cholangiocarcinoma patients, a pN1 category independently predicted poorer overall survival (hazard ratio: 3.40, 95% confidence interval: 1.14–10.11), while preoperative CA19-9 levels >30 U/mL (hazard ratio: 2.51, 95% confidence interval: 1.09–5.79) and pN1 category (hazard ratio: 2.51, 95% confidence interval: 1.09–5.79) predicted a shorter disease-free survival. Local recurrence was more common with perihilar cholangiocarcinoma (50% of recurrences), while multiple synchronous sites were more common for distal cholangiocarcinoma (41% of recurrences). Conclusion: Perihilar cholangiocarcinoma and distal cholangiocarcinoma patients have similar survival outcomes. However, local control appears to be more prognostic for perihilar cholangiocarcinoma patients, while positive lymph nodes are critical prognostic factor for distal cholangiocarcinoma patients.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 93%

Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal Cholangiocarcinomas

et al. 2019

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“…Interestingly, the univariate analysis revealed a statistical significance of surgery-related prognostic factors such as vein resection, which had a statistically significant impact on the long-term survival and surgical complications on the short-term survival in the Kaplan-Meier analysis. This is in concordance with some previous studies, which described a worse prognosis for patients after portal vein resection 36,50,51 , while other studies did not find statistically significant results 1,52 . A limitation for the evaluation of additional vein resection is the small number of patients who could be included, which in our study was only 15.6% of all patients.…”

Section: Discussionsupporting

confidence: 93%

The short- and long-term outcomes of pancreaticoduodenectomy for distal cholangiocarcinoma

Skalický¹,

Urban²,

Ehrmann³

et al. 2022

BIOMED PAP

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Background. 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. Patients and Methods. 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.Results. 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. Conclusion.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.

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“…The 3-year survival rate of patients without lymph node metastasis was significantly higher than that of patients with lymph node metastasis (66.3% vs 36.1%, p < 0.001). Byrling et al [17] showed that lymph node metastasis was the only independent risk factor for long-term survival of patients with distal cholangiocarcinoma (R = 2.88, p = 0.016). Our research also showed that the long-term prognosis of patients without lymph node metastasis was better than that of patients with lymph node metastasis (p = 0.000).…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Lyu

Zhao

et al. 2020

World J Surg Onc

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Background Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. Lymph node metastasis is widely accepted as an important prognostic factor for distal cholangiocarcinoma. The latest American Joint Committee on Cancer (AJCC) TNM classification system for distal cholangiocarcinoma has divided the lymph node metastasis patients into N1 and N2 by lymph node metastasis number. However, some studies suggested that the lymph node metastasis ratio may be better than the lymph node metastasis number. Therefore, we develop a program to analyze the correlation between lymph node parameters (lymph node dissection number, lymph node metastasis number, and lymph node metastasis rate) and long-term prognosis. Methods We retrospectively reviewed 123 distal cholangiocarcinoma patients after pancreatoduodenectomy from January 2011 to December 2019. The patients were grouped according to lymph node metastases and tumor-free and overall survival rates which were investigated with the Kaplan-Meier analysis. The logistic regression models were used for multivariate analysis to determine the risk factors for lymph node metastases. And the X-tile program was used to calculate the cutoff values for the lymph node parameters that discriminated survival. Results The 1-year, 3-year, and 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, and 31.5%, respectively. And the 1-year, 3-year, and 5-year overall survival rates of patients without and with lymph node metastasis were 83.0%, 50.7%, and 42.5% and 63.5%, 19.0%, and 19.0% (p = 0.000), respectively. Logistic regression showed CA19-9 and portal vein system invasion as independent risk factors for lymph node metastases. The receiver operating characteristic curve showed the optimal cutoff value of CA19-9 to predict the lymph node metastases was 75.5 U/mL. Determined by the X-tile software, the optimal cutoff values of the lymph node dissection number were 24 (p = 0.021), the lymph node metastasis number were 1 and 7 (p = 0.504), and the lymph node metastasis rate were 0.13 (p = 0.002). Conclusion Lymph node metastasis is an important factor affecting the long-term survival of distal cholangiocarcinoma patients.CA19-9 and portal vein system invasion are independent risk factors for lymph node metastasis. Besides, the lymph node dissection number and lymph node metastasis rate can predict the long-term survival better than lymph node metastasis number.

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Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma

Cited by 14 publications

References 48 publications

Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal Cholangiocarcinomas

Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal Cholangiocarcinomas

The short- and long-term outcomes of pancreaticoduodenectomy for distal cholangiocarcinoma

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

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