Treatment and survival of resected and unresected distal cholangiocarcinoma: a nationwide study

Abstract

Background: Population-based data on distal cholangiocarcinoma (DCC) from the Western world are not available, albeit essential to identify areas for improvement. This study investigated the incidence, treatment and outcomes, including time trends and predictors for survival, in a nationwide cohort of DCC. Methods: This is a retrospective cohort study of patients diagnosed with DCC (2009-2016) derived from the Netherlands Cancer Registry. Overall survival (OS) and its predictors were analyzed using Kaplan-Meier and Cox regression analysis. Time trends (2009-2012 versus 2013-2016) were assessed. Results: Overall, 1338 patients with DCC were included, with 1-, 3-and 5-year OS of 46%, 18%, and 11%. Incidence of DCC was 0.55-0.90 per 100.000 per year. Median OS was 10.4 months across all stages; 21.9 months for resected (n ¼ 620, 46.3%), 6.7 months for unresected nonmetastatic (n ¼ 445, 33.3%), and 3.6 months for metastatic DCC (n ¼ 273, 20.4%) (p < .001). After resection, 30-day mortality was 4.8% and 90-day mortality 7.7%. Patients with metastatic DCC who received chemotherapy (n ¼ 78, 28.6%) had a median OS of 8.2 versus 2.8 months for those not treated (p < .001). Over time, resection rates (53.6% to 61.7%, p ¼ .008) and use of palliative chemotherapy in metastatic DCC (22.3% to 32.9%, p ¼ .05) increased, without improvement in OS (10.3 vs 10.6 months, p ¼ .55). Independent poor prognostic factors for OS in resected disease were increasing age, pT3/T4 stage, higher lymph node ratio, poor differentiation, and R1 resection. Conclusions: In a nationwide cohort of DCC, resection rates and the use of chemotherapy increased whereas OS remained stable at 10.4 months.

Pancreaticoduodenectomy in a patient with intestinal malrotation and distal cholangiocarcinoma: a case report and review of the literature

“…During PD, arterial anomalies can increase the operative complexity of surgery, which is determined by the course of these arteries, but they do not usually compromise the safety of the procedure or its oncological outcome [13]. Body mass index, neutrophil-to-lymphocyte ratio, margin status, locoregional lymph node metastases, and the use of chemotherapy are the most important determinants of postsurgical outcomes [9,14,15].…”

Proposal of the optimal numbers of examined and positive lymph nodes to the 8th edition of American Joint Committee on Cancer (AJCC) staging for 758 patients with distal cholangiocarcinoma

“…And its incidence has gradually increased in recent year [5]. Although pancreaticoduodenectomy was the only potential treatment that can cure DCC patients with the resectable disease [6], the prognosis of patients with DCC after surgical resection was still poor, and the 5-year overall survival rates varied from 16-39.5% [7][8][9][10].…”

Periampulläre Tumoren: Epidemiologie, Klassifikation und Diagnostik

“…Vom RKI werden Tumoren der extrahepatischen Gallenwege, also auch proximale Gallengangkarzinome, Gallenblasenkarzinome und Karzinome der Ampulla Vateri zu einer Entität zusammengefasst. Daten aus den Niederlanden und den USA haben gezeigt, dass 30-42 % dieser Tumoren im distalen Teil des Gallenwegsystems lokalisiert sind [18,19] Die Häufigkeit der unterschiedlichen histologischen Subtypen ist regional und studienabhängig stark variabel. In den USA werden für den intestinalen Typ 49 % angegeben; der pankreatobiliäre Subtyp liegt in lediglich 21 % vor [10].…”