Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma.

Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Journal of Surgical Oncology (Impact Factor: 2.84). 04/2007; 95(3):207-12. DOI: 10.1002/jso.20668
Source: PubMed

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.

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    ABSTRACT: To identify the influence of the surgery type and prognostic factors in middle and distal bile duct cancers.
    World journal of gastroenterology : WJG. 06/2014; 20(21):6658-65.
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    ABSTRACT: Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). Accurate characterization and staging of these indolent cancers will determine outcome as majority of the patients’ are inoperable at the time of presentation. Ultrasound is useful for initial evaluation of the biliary tract and gallbladder masses and in determining the next suitable modality for further evaluation. Multimodality imaging plays an integral role in the management of the biliary tract malignancies. The imaging techniques most useful are MRI with MRCP, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and positron emission tomography (PET). In this review we will discuss epidemiology and the role of imaging in detection, characterization and management of the biliary tract malignancies under the three broad categories of cholangiocarcinomas (intra- and extrahepatic), gallbladder cancers and ampullary carcinomas.
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