title: Over 700 Whipples for Pancreaticobiliary Malignancies: Postoperative Morbidity Is an Additional Negative Prognostic Factor for Distal Bile Duct Cancer.
abstract: Distal cholangiocarcinomas and pancreatic cancers both arise from pancreaticobiliary epithelium. Despite their common origin, there is a possible discrepancy in outcome. We analysed the surgical, pathological and survival outcome of resected distal cholangiocarcinoma compared with pancreatic cancer.
  
  
  
  All cases of resected distal cholangiocarcinoma and pancreatic cancer from 1998 to 2014 were extracted from our database. Outcomes were compared.
  
  
  
  There were 54 (7.6%) cases of cholangiocarcinoma and 656 (92.4%) pancreatic cancer. Cholangiocarcinoma showed lower T and N stage, lymphatic and perineural invasion (p < 0.05), worse surgical outcome (p < 0.05) and less access to adjuvant therapy if compared with pancreatic cancer (72.7 vs. 83.1%, p = 0.05). Both showed a similar disease-specific survival (35 vs. 29 months, p = 0.3). Independent predictors of prognosis for pancreatic cancer were resection margin, grading, perineural invasion, T and N status, whereas for cholangiocarcinoma were grading and occurrence of POPF.
  
  
  
  Considering a large cohort of resected periampullary cancers, cholangiocarcinoma is extremely rare. An earlier diagnosis is associated with better pathological predictors of outcome but increased postoperative morbidity compared to pancreatic cancer, particularly POPF. Consequent decrease in the access to adjuvant therapy for complicated cholangiocarcinoma might explain why survival is as poor as for pancreatic cancer.
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Andrianello
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.affiliation: Department of Pathology, ARC-Net Research Center - University of Verona Hospital Trust, Verona, Italy.
authors.forename: Borislav Chavdarov
authors.initials: BC
authors.lastname: Rusev
authors.affiliation: Department of Pathology, ARC-Net Research Center - University of Verona Hospital Trust, Verona, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bonamini
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Maggino
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Department of General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. roberto.salvia@univr.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Adjuvant therapy; Distal cholangiocarcinoma; Outcomes; Pancreas cancer; Pancreaticoduodenectomy; Survival