Department of Oncology, St James's Institute of Oncology, Leeds, Sweden.
Br J Surg. 2014 Jan;101(2):89-99. doi: 10.1002/bjs.9367.
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 versus extrapancreatic CBD on margin status, overall (OS) and disease-free (DFS) survival.
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).
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 versus 13 of 27; P = 0.001), more often multifocal (P < 0.001) and more frequently affected the periductal margin (P = 0.005). Venous resection was more often required for CBDex cancers (P = 0.009). CBDex cancers were associated with worse OS (median 21 versus 28 months; P = 0.020) and DFS (14 versus 31 months; P = 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.
CBDex cancer is associated with a higher rate of R1 resection and venous resection after PD, and has a worse outcome than CBDin cancer.
影响胰十二指肠切除术（PD）治疗胆总管（CBD）癌患者生存的临床病理因素尚不清楚。本研究旨在探讨肿瘤累及胰内CBD 与胰外 CBD 对切缘状态、总生存期（OS）和无病生存期（DFS）的影响。
这是一项回顾性研究，纳入了 2001 年至 2009 年间接受 PD 治疗的 CBD 癌患者。根据之前描述的基于轴位切片的标准化方案进行病理检查。比较仅累及胰内 CBD（CBDin）、单独累及胰外 CBD 或合并累及胰内胆管部分（CBDex）的 CBD 癌患者的切缘状态、DFS 和 OS 等临床病理数据和结局。
共纳入 66 例患者。大多数 CBD 癌为局部晚期（97%为病理 T3，76%为 pN1）。CBDex 癌的镜下切缘受累（R1）较 CBDin 癌更为常见（39 例中有 34 例，27 例中有 13 例；P = 0.001），多灶性更为常见（P < 0.001），更常累及胆管周围切缘（P = 0.005）。CBDex 癌更常需要进行静脉切除（P = 0.009）。CBDex 癌的 OS（中位 21 个月与 28 个月；P = 0.020）和 DFS（14 个月与 31 个月；P = 0.015）更差，但复发的部位和类型没有差异。转移至超过 2 个淋巴结是 OS 和 DFS 的独立预测因素。
CBDex 癌与 PD 后 R1 切除和静脉切除的发生率较高相关，其预后较 CBDin 癌差。
