title: Adenocarcinoma of the distal bile duct. A clinicopathologic outcome analysis after curative resection.
abstract: OBJECTIVE
  Primary distal bile duct adenocarcinomas (DBDAs) are unusual neoplasms, necessitating pancreaticoduodenectomy for cure. The aims of this study were to evaluate the prognostic importance of lymphatic and perineural invasion, long-term outcome of patients after resection, and differences in outcome with hilar cholangiocarcinoma and pancreatic carcinoma.
  
  
  METHODS
  The medical records and histopathological slides of 15 patients (8 men and 7 women) with documented DBDA after curative pancreaticoduodenectomy were reviewed.
  
  
  RESULTS
  Nine standard and 6 pylorus-preserving pancreaticoduodenectomies were performed. TNM staging included 1, 3, 2, 8, and 1 patient in stages I, II, III, and IVA and IVB, respectively. Lymphatic and perineural invasion was present in 4 (27%) and 9 (60%) patients, respectively. With multivariate analysis only serum bilirubin was a significant prognostic factor. Median survival was 21 months, and 2- and 5-year actuarial survivals were 40 and 20%, respectively. Median survival with adjuvant therapy (n = 6) was 21 months, with 5-year survival of 33%. Five-year actuarial survivals when lymphatic or perineural invasion was present were 0 and 11%, respectively.
  
  
  CONCLUSIONS
  DBDA is aggressive, but entails a better prognosis than pancreatic ductal or more proximal bile duct carcinoma. Lymphatic and/or perineural invasion worsen survival.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: L
authors.initials: L
authors.lastname: Bortolasi
authors.forename: L J
authors.initials: LJ
authors.lastname: Burgart
authors.forename: G G
authors.initials: GG
authors.lastname: Tsiotos
authors.forename: E
authors.initials: E
authors.lastname: Luque-De León
authors.forename: M G
authors.initials: MG
authors.lastname: Sarr
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin