Survival outcome and prognostic factors after pancreatoduodenectomy for distal bile duct carcinoma: a retrospective multicenter study
Pancreatoduodenectomy is the most common operative procedure performed for distal bile duct carcinoma. Data on outcome after surgery for this rare malignancy is scarce, especially from western countries. The purpose of this study is to explore the prognostic factors and outcome after pancreatoduodenectomy for distal bile duct carcinoma.
Patients receiving pancreatoduodenectomy for distal bile duct carcinoma were identified from institutional databases of five German and one Russian academic centers for pancreatic surgery. Univariable and multivariable general linear model, Kaplan-Meier method, and Cox regression were used to identify prognostic factors for postoperative mortality and overall survival.
N = 228 patients operated from 1994 to 2015 were included. Reoperation (OR 5.38, 95%CI 1.51–19.22, p = 0.010), grade B/C postpancreatectomy hemorrhage (OR 3.73, 95%CI 1.13–12.35, p = 0.031), grade B/C postoperative pancreatic fistula (OR 4.29, 95%CI 1.25–14.72, p = 0.038), and advanced age (OR 4.00, 95%CI 1.12–14.03, p = 0.033) were independent risk factors for in-hospital mortality in multivariable analysis. Median survival was 29 months, 5-year survival 27%. Positive resection margin (HR 2.07, 95%CI 1.29–3.33, p = 0.003), high tumor grade (HR 1.71, 95%CI 1.13–2.58, p = 0.010), lymph node (HR 1.68, 95%CI 1.13–2.51, p = 0.011), and distant metastases (HR 2.70, 95%CI 1.21–5.58, p = 0.014), as well as severe non-fatal postoperative complications (HR 1.64, 95%CI 1.04–2.58, p = 0.033) were independent negative prognostic factors for survival in multivariable analysis.
Distant metastases and positive resection margin are the strongest negative prognostic factors for survival after pancreatoduodenectomy for distal bile duct carcinoma; thus, surgery with curative intent is only warranted in patients with local disease, where R0 resection is feasible.
KeywordsDistal bile duct carcinoma Pancreatoduodenectomy Pancreatic surgery Distal cholangiocarcinoma Periampullary carcinoma
Study conception and design: Felix Rückert, Ulrich Wellner, Gabriel Seifert, Ekaterina Petrova. Acquisition of data: Sebastian Zach, Jürgen Weitz, Robert Grützmann, Uwe Wittel, Frank Makowiec, Ulrich Hopt, Peter Bronsert, Florian Kühn, Bettina M. Rau, Roman Izrailov, Igor Khatkov, Hryhoriy Lapshyn, Dirk Bausch. Analysis and interpretation of data: Ekaterina Petrova, Ulrich Wellner, Louisa Bolm, Gabriel Seifert, YinFen Shen, Tobias Keck. Drafting of manuscript: Ekaterina Petrova, YinFen Shen. Critical revision of manuscript: Ekaterina Petrova, Felix Rückert, Sebastian Zach, YinFeng Shen, Jürgen Weitz, Robert Grützmann, Uwe Wittel, Frank Makowiec, Ulrich Hopt, Peter Bronsert, Florian Kühn, Bettina M. Rau, Roman Izrailov, Igor Khatkov, Hryhoriy Lapshyn, Louisa Bolm, Dirk Bausch, Tobias Keck, Ulrich F. Wellner, Gabriel Seifert.
Compliance with ethical standards
This study was supported by the German Research Foundation (DFG WE5085/1-1), Scientific Research Fund from Hubei University of Chinese Medicine, Education Project of Medical Talents for Young and Middle-aged in Wuhan City (Grant No. Q2014037), and Young Talents Project of Science and Technology Research Program from Hubei Provincial Department of Education (Grant No. Q20132003).
Conflict of interest
The authors declare that they have no conflict of interest.
Approval for the study was obtained from the institutional ethics committee of the University of Lübeck (Ref 14-037A). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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