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Intra-pancreatic distal cholangiocarcinoma and pancreatic ductal adenocarcinoma: a common short and long-term prognosis?

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Abstract

The aim of the study was to compare histological features, postoperative outcomes, and long-term prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma. From 2005 to 2017, 188 pancreaticoduodenectomies (pancreatic ductal adenocarcinoma n = 151, distal cholangiocarcinoma n = 37) were included. Postoperative outcomes were compared after matching on pancreatic gland texture and main pancreatic duct size. Matching according to tumor size, lymph node invasion and resection margin was used to compare overall and disease-free survival. Distal cholangiocarcinoma patients had more often “soft” pancreatic gland (P = 0.002) and small size main pancreatic duct (P = 0.001). Pancreatic ductal adenocarcinoma patients had larger tumors (P = 0.009), and higher lymph node ratio (P = 0.017). Severe morbidity (P = 0.023) and clinically relevant pancreatic fistula (P = 0.018) were higher in distal cholangiocarcinoma patients. After matching on gland texture and main pancreatic duct diameter, clinically relevant postoperative pancreatic fistula was still more frequent in distal cholangiocarcinoma patients (P = 0.007). Tumor size > 20 mm was predictive of impaired overall survival (P = 0.024) and disease-free survival (P = 0.003), tumor differentiation (P = 0.027) was predictive of impaired overall survival. Survival outcomes for distal cholangiocarcinoma and pancreatic ductal cholangiocarcinoma were similar after matching patients according to tumor size, lymph node invasion and resection margin. Long-term outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma patients are similar. Postoperative course is more complicated after pancreaticoduodenectomy for distal cholangiocarcinoma than pancreatic ductal adenocarcinoma. After pancreaticoduodenectomy, patients with distal cholangiocarcinoma and pancreatic ductal adenocarcinoma have similar long-term oncological outcomes.

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Data availability

In two tertiary referral centers, data was extracted from a prospectively maintained database and were analyzed retrospectively.

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Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France

    Théophile Guilbaud, Ghislain Schlienger, Stéphane Berdah, Vincent Moutardier & David Jérémie Birnbaum

  2. Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France

    Edouard Girard, Oyekashopefoluw Alao, Olivier Risse & Mircea Chirica

  3. Self Perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Marseille, France

    Coralie Lemoine

Authors
  1. Théophile Guilbaud
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  2. Edouard Girard
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  3. Coralie Lemoine
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  4. Ghislain Schlienger
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  5. Oyekashopefoluw Alao
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  6. Olivier Risse
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  10. David Jérémie Birnbaum
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Contributions

TG, GS, VM, and DJB: conception and design; SB, MC, VM, and DJB: administrative support; TG, EG, GS, OA, OR, and DJB: provision of study materials or patients; TG, EG, CL, GS, OA: collection and assembly of data; TG, CL, MC, DJB: data analysis and interpretation; the first draft of the manuscript was written by TG, DJB, and MC. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Théophile Guilbaud.

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Conflicts of interest

There are no conflicts of interest or financial disclosure to declare.

Ethics approval

The study was conducted in accordance with the Declaration of Helsinki, and was reviewed and approved by the local ethical committees of both representative institutions (No. 2018-25-04-001).

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All patients enrolled completed the informed consent for participate and publication.

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Guilbaud, T., Girard, E., Lemoine, C. et al. Intra-pancreatic distal cholangiocarcinoma and pancreatic ductal adenocarcinoma: a common short and long-term prognosis?. Updates Surg 73, 439–450 (2021). https://doi.org/10.1007/s13304-021-00981-0

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  • DOI: https://doi.org/10.1007/s13304-021-00981-0

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