Journal of Gastrointestinal Surgery

, Volume 21, Issue 3, pp 527–533 | Cite as

Over 700 Whipples for Pancreaticobiliary Malignancies: Postoperative Morbidity Is an Additional Negative Prognostic Factor for Distal Bile Duct Cancer

  • Stefano Andrianello
  • Giovanni Marchegiani
  • Giuseppe Malleo
  • Borislav Chavdarov Rusev
  • Aldo Scarpa
  • Deborah Bonamini
  • Laura Maggino
  • Claudio Bassi
  • Roberto Salvia
Original Article



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.


Pancreaticoduodenectomy 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.

Author’s Contribution

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.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Stefano Andrianello
    • 1
  • Giovanni Marchegiani
    • 1
  • Giuseppe Malleo
    • 1
  • Borislav Chavdarov Rusev
    • 2
  • Aldo Scarpa
    • 2
  • Deborah Bonamini
    • 1
  • Laura Maggino
    • 1
  • Claudio Bassi
    • 1
  • Roberto Salvia
    • 1
  1. 1.Department of General and Pancreatic Surgery - The Pancreas InstituteUniversity of Verona Hospital TrustVeronaItaly
  2. 2.Department of PathologyARC-Net Research Center - University of Verona Hospital TrustVeronaItaly

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