Prognostic Factors After Pancreatoduodenectomy With Extended Lymphadenectomy for Distal Bile Duct Cancer

Abstract

Background: Since 1995, we have been performing pancreatoduodenectomy with regional and para-aortic lymph node dissection for patients with distal bile duct cancer. Prognostic indicators after extended lymphadenectomy have not been fully understood.Hypothesis: Pancreatoduodenectomy with extended lymphadenectomy and adjuvant chemotherapy is the treatment of choice for patients with distal bile duct cancer.Design: In a retrospective study, univariate and multivariate models were used to analyze the effect of patient demographics, tumor characteristics, and treatment factors on long-term survival.Setting: Oita Medical University and its affiliated hospitals in Japan.Patients: From 1995 to 1999, 27 patients with distal bile duct cancer underwent pancreatoduodenectomy with extended lymphadenectomy. In 9 patients fluorouracil (500 mg/d) was infused continuously for 14 days after surgery as adjuvant chemotherapy. Main Outcome Measures: Clinicopathologic characteristics and long-term results.Results: In 6 patients (22%) major surgical complications occurred including 1 in-hospital death (3.7%). For 26 patients, the survival rates were 65% for 1 year and 37% for 3 and 5 years. Univariate analysis found that the absence of lymph node metastasis, no more than 2 involved nodes, and negative resection margins were predictors of survival. Multivariate analysis with a Cox proportional hazards regression model revealed that favorable factors for survival included up to 2 positive nodes, negative resection margins, and the use of postoperative adjuvant chemotherapy. Conclusions:Patients with up to 2 positive lymph nodes had a more favorable prognosis than that of other patients. We recommend pancreatoduodenectomy with extended lymphadenectomy and adjuvant chemotherapy for the treatment of patients with distal bile duct cancer.

Carcinoma of the middle bile duct: Is bile duct segmentalresection appropriate?

“…Furthermore, the cell differentiation, the T stage and the TNM stage were significant factors that affected the outcomes. It has been reported that the frequency of LN metastasis in DBD ranged from 30% to 68% [7,8,11,14,20,23] , and negative LN metastasis was a useful predictor of a favorable outcome for patients with DBD [7,8,14,23] . However, perineural invasion did not prove to be statistically significant, unlike the other studies that reported the risk factors for survival from cholangiocarcinoma in other parts of the biliary tree [24,25] .…”

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

“…Several staging schemes have been proposed, but none correlates with resectability. Lymph node involvement is also a predictor of survival [48,51] .…”

Prognostic factors in patients with advanced cholangiocarcinoma: Role of surgery, chemotherapy and body mass index

“…In previous studies, variables such as low preoperative bilirubin [4,14,28,29] , radical resection [28,29] , negative resection margin [11,30] and well-differentiated tumor histology [1,31] …”

“…Some studies suggest that chemotherapy, whether given in a setting of non-resectable disease or postoperatively, has little or no impact on the course of the disease or on survival outcome [13][14][15]29,[39][40][41] and is therefore considered palliative more than curative [42] . Other studies report survival benefit from chemotherapy [11,12,43] . Recently, a pooled analysis of all clinical trials from 1985 to 2007 concluded that the combination of gemcitabine with oxaliplatin or cisplatin may improve survival in cholangiocarcinoma [10] .…”

“…This is due to lack of randomized clinical trials, and absence of a standard chemotherapeutic regimen [10] . While some authors believe that chemotherapy prolongs survival in cholangiocarcinoma [11,12] , others deny this survival benefit [13][14][15] . The impact of excess body weight on survival in patients with different cancers is variable.…”