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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Murakami
Yoshiaki
Y
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. mura777@hiroshima-u.ac.jp
Uemura
Kenichiro
K
Hayashidani
Yasuo
Y
Sudo
Takeshi
T
Hashimoto
Yasushi
Y
Ohge
Hiroki
H
Sueda
Taijiro
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate