Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma.
ABSTRACT Prognostic indicators for patients with distal cholangiocarcinoma have not been confirmed because of its rarity. The aim of this study was to identify useful prognostic factors in patients undergoing surgical resection for distal cholangiocarcinoma.
Charts of 43 patients with distal cholangiocarcinoma who underwent surgical resection were retrospectively reviewed. Pancreatoduodenectomy was performed in 35 patients, and segmental bile duct resection in 8. Potential clinicopathological prognostic factors were examined by univariate and multivariate survival analysis.
Postoperative complications occurred after surgery in 19 patients (44%), but there was no mortality. Overall survival rates were 72%, 53%, and 44% for 1, 3, and 5 years, respectively (median survival time, 26.0 months). Univariate analysis found that older age, pathological pancreatic invasion, lymph node metastasis, perineural invasion, positive surgical margin, and TNM stages II and III were significant predictors of poor prognosis (P < 0.05). Furthermore, lymph node metastasis and positive surgical margin were found to be significant independent predictors of poor prognosis with a Cox proportional hazards regression model (P < 0.05).
These results suggest that lymph node metastasis and positive surgical margin as determined by surgical resection might be useful in predicting post-surgical outcome in patients with distal cholangiocarcinoma.
- SourceAvailable from: Quanda Liu[show abstract] [hide abstract]
ABSTRACT: To investigate the incidence of clinically detected port-site metastasis (PSM) in patients who underwent robotic surgery for biliary malignancies. Using a prospective database, the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included. Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM. Sixty-four patients with biliary tract cancers underwent robotic surgery, and sixty patients met the inclusion criteria. The median age was 67 year (range: 40-85 year). During a median 15-mo follow-up period, two female patients were detected solitary PSM after robotic surgery. The incidence of PSM was 3.3%. Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor. She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar. Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer. She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo. The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma. The incidence of PSMs after robotic surgery for biliary malignancies is relatively low, and biliary cancer can be an indication of robotic surgery.World Journal of Gastroenterology 10/2012; 18(40):5695-701. · 2.55 Impact Factor
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ABSTRACT: Background The current standard treatment for extrahepatic distal bile duct carcinoma (EDBDC) is surgical resection, as no effective alternative treatment exists. In this study, we investigated the treatment strategies and outcomes for 90 cases of EDBDC at our department. Material and Methods Between April 2000 and March 2013, 90 pancreatoduodenectomies (PDs) were performed for EDBDC. The mean patient age was 69.1±9.8 years, and there were 59 males and 31 females. Extended lymph adenectomy including lymph nodes around the common hepatic artery and celiac axis was performed in all patients. The mean operation time was 537.1±153.8 min and the mean operative blood loss was 814.0±494.0 ml. There were no operation-related deaths. The overall 1-, 3-, and 5-year survival rates were 90.0%, 51.2%, and 45.0%, respectively. Results Lymph node metastasis was present in 28 patients (N+; 31.1%), and it was absent in 62 (N-; 68.9%). The 5-year survival rate was 20.0% for N+ patients and 52.4% for N- patients, which is significantly higher (P=0.03). Nine cases (10.0%) showed hepatic-side ductal margin (HM) positivity for carcinoma. The 5-year survival rate was 18.7% for HM-positive patients and 48.3% for HM-negative patients, which is significantly higher (P=0.005). In multivariate analysis, N+ was the strongest adverse prognostic factor. Subclass analysis of 62 cases (excluding 28 N+ cases) revealed 7 patients with positive HMs (11.3%) and 55 patients with negative HMs (88.7%). The 5-year survival rate was 47.6% for HM-positive patients and 49.8% for HM-negative patients (P=0.73). Thirty-five cases (38.9%) recurred: there were 19 cases of local recurrence (21.1%), 11 cases of liver metastasis (12.2%), 4 cases of distant recurrence (4.4%), and 1 case of para-aortic lymph node metastasis (1.1%). Conclusions In conclusion, when HM is positive in N+ cases, additional resection of the bile duct is not necessary to render the HM negative for carcinoma.Medical science monitor: international medical journal of experimental and clinical research 01/2014; 20:471-5. · 1.36 Impact Factor
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ABSTRACT: PURPOSE: Adjuvant chemotherapy is accepted as a standard treatment after surgical resection of pancreatic carcinoma; however, the optimal timing between surgery and initiation of adjuvant chemotherapy has not been reported. The aim of this study was to determine the optimal timing of adjuvant chemotherapy after surgical resection of pancreatic carcinoma. METHODS: Records of 104 patients who received adjuvant chemotherapy after curative surgical resection of pancreatic carcinoma were reviewed retrospectively. Patients were grouped according to whether they received initial adjuvant chemotherapy within 20 days after surgery (≦20 days, n = 57) or more than 20 days after surgery (>20 days, n = 47). Relationships between time to initiation of adjuvant chemotherapy, other clinicopathological factors, and survival were analyzed. RESULTS: The rate of postoperative complication was significantly lower than in the ≦20 days group compared with the >20 days group (P = 0.003); no significant difference in other clinicopathological factors was found. Multivariate analysis revealed that time to initiation of adjuvant chemotherapy was an independent prognostic factor of disease-free survival (P = 0.009) and overall survival (P = 0.037). The ≦20 days group had longer 5-year overall survival rates than did the >20 days group (52 vs. 26 %, P = 0.013) as well as longer 5-year disease-free survival rates (53 vs. 22 %, P = 0.007). CONCLUSIONS: Adjuvant chemotherapy for patients with resected pancreatic carcinoma should be initiated as soon as possible after surgical resection. Prevention of postoperative complication is needed to enable early initiation.Cancer Chemotherapy and Pharmacology 11/2012; · 2.80 Impact Factor