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