J Korean Surg Soc.  2013 Nov;85(5):212-218.

Prognostic factors following surgical resection of distal bile duct cancer

• Chung YJ
• Choi DW
• Choi SH
• Heo JS
• Kim DH

Abstract

PURPOSE
Prognostic factors for distal bile duct cancer are contentious. This study was conducted to analyze the prognostic factors of distal bile duct cancer after surgery with the aim of identifying those associated with diminished survival.
METHODS
Two hundred forty-one patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) or Whipple procedure in our tertiary hospital from February 1995 to June 2011 were retrospectively analyzed. All patients were pathologically proven to have distal bile duct adenocarcinoma. Postoperative complications, survival, and well-known prognostic factors after resection for distal bile duct cancer were investigated.
RESULTS
Preoperative elevated carbohydrate antigen 19-9 (CA 19-9) level (P = 0.006), positive resection margin (P < 0.001), advanced T stage (P = 0.043), and lymph node metastasis (P = 0.002) were significantly independent worse prognostic indicators by multivariate analysis of resectable distal bile duct cancer.
CONCLUSION
R0 resection is the most important so that frozen sections should be utilized aggressively during each operation. For the distal bile duct cancer with elevated preoperative CA 19-9 level or advanced stage, further study on postoperative adjuvant treatment may be warranted.

Keyword

Bile duct cancer; CA-19-9 antigen; Pancreaticoduodenectomy

MeSH Terms

Adenocarcinoma
Bile Duct Neoplasms*
Bile Ducts*
Bile*
CA-19-9 Antigen
Frozen Sections
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Pancreaticoduodenectomy
Postoperative Complications
Retrospective Studies
Tertiary Care Centers
CA-19-9 Antigen

Figure

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  Fig. 1 Overall survival curve.

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  Fig. 2 Survival difference according to preoperative serum carbohydrate antigen 19-9. PPPD, pancreaticoduodenectomy.

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  Fig. 3 Survival difference according to lymph node metastasis. PPPD, pancreaticoduodenectomy.

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  Fig. 4 Survival difference according to resection margin.

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