Impact of intrapancreatic or extrapancreatic bile duct involvement on survival following pancreatoduodenectomy for common bile duct cancer. Issue 2 (January 2014)

• Record Type: Journal Article
• Authors: Kamposioras, K.; Anthoney, A.; Fernández Moro, C.; Cairns, A.; Smith, A. M.; Liaskos, C.; Verbeke, C. S.
• Is Part Of: British journal of surgery. Volume 101:Issue 2(2014:Feb.)
• Page Start: 89
• Page End: 99
• Publication Date: 2014-01
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9367
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" id="bjs9367-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjs9367-sec-0001" sec-type="section"> <title>Background</title> <p> <bold>The clinicopathological factors that influence survival following pancreatoduodenectomy (PD) for common bile duct (CBD) cancer are not well known. This study aimed to investigate the effect of tumour involvement of the intrapancreatic <italic>versus</italic> extrapancreatic CBD on margin status, overall (OS) and disease‐free (DFS) survival.</bold> </p> </sec> <sec id="bjs9367-sec-0002" sec-type="section"> <title>Methods</title> <p> <bold>This was a retrospective study of patients who underwent PD for CBD cancer between 2001 and 2009. Pathological examination was performed according to a previously described standardized protocol based on axial slicing. Clinicopathological data and outcome in terms of margin status, DFS and OS were compared between cancers involving exclusively the intrapancreatic CBD (CBDin) and those involving the extrapancreatic CBD, in isolation or combined with invasion of the intrapancreatic part of the duct (CBDex).</bold> </p> </sec> <sec id="bjs9367-sec-0003" sec-type="section"> <title>Results</title> <p> <bold>A total of 66 patients were enrolled. Most CBD cancers were locally advanced (97 per cent pathological (p) T3, 76 per cent pN1). Microscopic margin involvement (R1) was more frequent in CBDex than in CBDin cancers (34 of 39 <italic>versus</italic> 13 of 27; <italic>P</italic> = 0·001), more often multifocal (<italic>P</italic> < 0·001) and more frequently affected the periductal margin (<italic>P</italic> = 0·005). Venous resection was more often required for CBDex cancers (<italic>P</italic> = 0·009). CBDex cancers were associated with worse OS (median 21 <italic>versus</italic> 28 months; <italic>P</italic> = 0·020) and DFS (14 <italic>versus</italic> 31 months; <italic>P</italic> = 0·015), but the rate and site of recurrence did not differ. Metastasis to more than two lymph nodes was an independent predictor of OS and DFS.</bold> </p> </sec> <sec id="bjs9367-sec-0004" sec-type="section"> <title>Conclusion</title> <p> <bold>CBDex cancer is associated with a higher rate of R1 resection and venous resection after PD, and has a worse outcome than CBDin cancer.</bold> </p> </sec> </abstract>