Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma
Department of Surgery, Hiroshima University, Hirosima, Hiroshima, Japan Journal of Surgical Oncology
(Impact Factor: 3.24).
03/2007; 95(3):207-12. DOI: 10.1002/jso.20668
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.
Available from: upenn.edu
- "University of Louvain (Belgium) 1984 d 5 4 0 2 0 0 d d d d d d d d 10.6 Fong, et al  Memorial-Sloan Kettering 1996 104 45 (43) 79 46 27 33 d d 54 d d 0 4.4 d Nakeeb, et al  Johns Hopkins 1996 d 73 70 31 28 22 89 38 30 50 a 8 a 8 a 0 d Wade, et al  VA Medical Center, St. Louis 1997 156 34 (22) 69 a 18 a 14 15 a d d 22 d 0 0 11 d Bortolasi, et al  Mayo Clinic 2000 d 15 d d 20 21 d d 33 d d 0 0 d 1442 VEILLETTE & CASTILLO Yoshida, et al  Nakatsu Municipal Hospital (Japan) 2002 d 27 65 37 37 20.5 91 61 61 47 20 20 3.7 d Murakami, et al  Hiroshima University (Japan) 2007 d 43 72 53 44 26 94 a 76 a 58 40 a 21 a 21 0 d Ebata, et al  Nagoya University (Japan) 2007 d 100 75 47 35 30 86 60 46 57 25 19 5 d Cheng, et al  Second Military Medical University (China) 2007 131 116 (89) 86 51 25 35.5 94 62 30 56 12 4 3.4 d DeOliveira, et al  Johns Hopkins 2007 d 229 d d 23 18 d d 30 a d d 15 a 3 d a Estimated from survival curve. "
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ABSTRACT: Distal cholangiocarcinoma (malignancy in the common bile duct from the cystic duct to the ampulla) remains a rare diagnosis. Most of these lesions are adenocarcinomas, and typically present with painless jaundice. If suspected, a high-quality CT scan and endoscopic retrograde cholangiopancreatography are required for diagnosis and staging. In addition, identification of risk factors, use of tumor markers, and advanced molecular testing may enhance diagnostic and prognostic capabilities. The treatment of choice for resectable disease is pancreaticoduodenectomy and the overall 5-year survival for resected distal cholangiocarcinoma remains 20% to 30%.
Available from: Heike Loeser
- "Jang et al. reported that 6 out of 49 actual 5-year survivors had either microscopic tumor disease (n 03) or positive lymph nodes (n 03) in the resected specimens . In a study by Murakami et al., 3 out of 17 lymph-node-positive patients survived more than 5 years . Lillemoe et al. showed that, for pancreatic carcinoma, patients with localized disease who underwent pancreaticoduodenectomy with evidence of gross or microscopic disease "
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ABSTRACT: The aims of the guidelines are to help assess the evidence for palliation surgery in patients with cholangiocarcinoma (CCA). The guidelines are classified in accordance with the location of the primary lesion, i.e. intrahepatic, hilar, and distal. They are based on comprehensive literature surveys, including results from randomized controlled trials, systematic reviews and meta-analysis, and cohort, prospective, and retrospective studies. Intrahepatic CCA, i.e. resection of lymph-node-positive tumors and R1/R2 resections have not been shown to provide survival benefit: Evidence levels: 2b, 4; Recommendation grade C. Hilar CCA: R1 resection is justified as a very efficient palliation. Non-surgical biliary stenting is the first choice of palliative biliary drainage. Distal CCA: Resection of lymph-node-positive tumours and R1/R2 resections should be performed. Non-surgical stenting is regarded as the first choice of palliation for patients with short life expectancy. For patients with longer projected survival, surgical bypass should be considered. Palliative resections have a relevant beneficial impact on the outcome of patients with distal and hilar CCA. Non-surgical stenting is the first choice of palliative biliary drainage for patients with hilar CCA and for those with distal CCA and short life expectancy. For patients with distal CCA and longer projected survival, surgical bypass should be considered.
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