Over 700 Whipples for Pancreaticobiliary Malignancies: Postoperative Morbidity Is an Additional Negative Prognostic Factor for Distal Bile Duct Cancer
- 310 Downloads
Distal cholangiocarcinomas and pancreatic cancers both arise from pancreaticobiliary epithelium. Despite their common origin, there is a possible discrepancy in outcome. We analysed the surgical, pathological and survival outcome of resected distal cholangiocarcinoma compared with pancreatic cancer.
All cases of resected distal cholangiocarcinoma and pancreatic cancer from 1998 to 2014 were extracted from our database. Outcomes were compared.
There were 54 (7.6%) cases of cholangiocarcinoma and 656 (92.4%) pancreatic cancer. Cholangiocarcinoma showed lower T and N stage, lymphatic and perineural invasion (p < 0.05), worse surgical outcome (p < 0.05) and less access to adjuvant therapy if compared with pancreatic cancer (72.7 vs. 83.1%, p = 0.05). Both showed a similar disease-specific survival (35 vs. 29 months, p = 0.3). Independent predictors of prognosis for pancreatic cancer were resection margin, grading, perineural invasion, T and N status, whereas for cholangiocarcinoma were grading and occurrence of POPF.
Considering a large cohort of resected periampullary cancers, cholangiocarcinoma is extremely rare. An earlier diagnosis is associated with better pathological predictors of outcome but increased postoperative morbidity compared to pancreatic cancer, particularly POPF. Consequent decrease in the access to adjuvant therapy for complicated cholangiocarcinoma might explain why survival is as poor as for pancreatic cancer.
KeywordsPancreaticoduodenectomy Pancreas cancer Distal cholangiocarcinoma Outcomes Survival Adjuvant therapy
This work was supported by Associazione Italiana Ricerca Cancro [AIRC n. 12182 and n. 17132]; Italian Ministry of Health [FIMP-CUP_J33G13000210001]; FP7 European Community Grant Cam-Pac [n. 602783]. The funding agencies had no role in the collection, analysis and interpretation of data and in the writing of the manuscript.
Stefano Andrianello: study design, data retrieval, statistical analysis, draft of the manuscript
Giovanni Marchegiani: study design, critical analysis, review of the manuscript
Giuseppe Malleo: critical analysis, review of the manuscript
Borislav Chavdarov Rusev: pathological analysis
Aldo Scarpa: pathological analysis, critical analysis, review of the manuscript
Deborah Bonamini: data retrieval
Laura Maggino: data retrieval
Claudio Bassi: critical analysis, review of the manuscript
Roberto Salvia: study design, critical analysis, review of the manuscript
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 5.Adsay V, Mino-Kenudson M, Furukawa T, Basturk O, Zamboni G, Marchegiani G, Bassi C, Salvia R, Malleo G, Paiella S, Wolfgang CL, Matthaei H, Offerhaus GJ, Adham M, Bruno MJ, Reid MD, Krasinskas A, Klöppel G, Ohike N, Tajiri T, Jang K-T, Roa JC, Allen P, Fernández-del Castillo C, Jang J-Y, Klimstra DS, Hruban RH, Members of the Verona Consensus Meeting, 2013. Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. Annals of Surgery. March 2015:1.Google Scholar
- 7.Minagawa N, Sato N, Mori Y, Tamura T, Higure A, Yamaguchi K. A comparison between intraductal papillary neoplasms of the biliary tract (BT-IPMNs) and intraductal papillary mucinous neoplasms of the pancreas (P-IPMNs) reveals distinct clinical manifestations and outcomes. Eur J Surg Oncol. 2013;39(6):554–558.CrossRefPubMedGoogle Scholar
- 9.Chung YJ, Choi DW, Choi SH, Heo JS, Kim DH. Prognostic factors following surgical resection of distal bile duct cancer. 2013;85(5):212–218.Google Scholar
- 11.Hamilton SR, Aaltonen LA. WHO Classification. Tumours of the Digestive System: Pathology & Genetics. 2000.Google Scholar
- 12.Bosman FT, Carneiro F, Hruban RH. WHO Classification of Tumours of the Digestive System. World Health Organization; 2010.Google Scholar
- 13.Armed Forces Institute of Pathology (U.S.), Pathology UAFRAEI. Atlas of Tumor Pathology. American Registry of Pathology; 2000.Google Scholar
- 18.Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). In: Surgery. Vol 142. 2007:761–768.Google Scholar
- 19.Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. In: Surgery. Vol 138. 2005:8–13.Google Scholar
- 23.Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. 2007;31(2):337–42–discussion343–4.Google Scholar
- 26.Čečka F, Jon B, Šubrt Z, Ferko A. Clinical and economic consequences cf pancreatic fistula after elective pancreatic resection. Hepatobiliary & Pancreatic Diseases …. 2013;12(5):533–539..Google Scholar
- 27.Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, COLEMAN J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Annals of Surgery. 1997;226(3):248–57–discussion257–60.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Wellner UF, Shen Y, Keck T, Jin W, Xu Z. The survival outcome and prognostic factors for distal cholangiocarcinoma following surgical resection: a meta-analysis for the 5-year survival. Surg Today. May 2016:1–9.Google Scholar
- 35.Im JH, Seong J, Lee IJ, Park JS, Yoon DS, Kim KS, Lee WJ, Park KR. Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients. Cancer Res Treat. July 2015.Google Scholar
- 38.Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T, Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95(8):1685–1695.CrossRefPubMedGoogle Scholar