University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Hospital Clínic de Barcelona, Barcelona, Spain.
Eur J Surg Oncol. 2024 Jun;50(6):108353. doi: 10.1016/j.ejso.2024.108353. Epub 2024 Apr 22.
Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select patients who could benefit from additional systemic or locoregional therapies. This multicentre retrospective cohort study aimed to determine timing, patterns, and predictive factors of recurrence following pancreaticoduodenectomy for dCCA.
Patients who underwent pancreaticoduodenectomy for dCCA between June 2012 and May 2015 with five years of follow-up were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on comorbidities, investigations, operation details, complications, histology, adjuvant and palliative therapies, recurrence-free and overall survival. Univariable tests and regression analyses investigated factors associated with recurrence.
In the cohort of 198 patients, 129 (65%) developed recurrence: 30 (15%) developed local-only recurrence, 44 (22%) developed distant-only recurrence and 55 (28%) developed mixed pattern recurrence. The most common recurrence sites were local (49%), liver (24%) and lung (11%). 94% of patients who developed recurrence did so within three years of surgery. Predictors of recurrence on univariable analysis were cancer stage, R1 resection, lymph node metastases, perineural invasion, microvascular invasion and lymphatic invasion. Predictors of recurrence on multivariable analysis were female sex, venous resection, advancing histological stage and lymphatic invasion.
Two thirds of patients have cancer recurrence following pancreaticoduodenectomy for dCCA, and most recur within three years of surgery. The commonest sites of recurrence are the pancreatic bed, liver and lung. Multiple histological features are associated with recurrence.
接受胰十二指肠切除术治疗远端胆管癌（dCCA）的患者常发生癌症复发。确定复发的时间、模式和危险因素可能有助于为监测方案策略提供信息，或选择可能从额外的全身或局部区域治疗中获益的患者。本多中心回顾性队列研究旨在确定 dCCA 行胰十二指肠切除术后复发的时间、模式和预测因素。
纳入 2012 年 6 月至 2015 年 5 月期间接受 dCCA 胰十二指肠切除术且随访时间达 5 年的患者。主要结局为复发模式（无、局部、远处或混合局部/远处）。收集了合并症、检查、手术细节、并发症、组织学、辅助和姑息治疗、无复发生存和总生存的数据。使用单变量检验和回归分析探讨了与复发相关的因素。
在 198 例患者的队列中，129 例（65%）发生了复发：30 例（15%）发生了局部复发，44 例（22%）发生了远处复发，55 例（28%）发生了混合模式复发。最常见的复发部位是局部（49%）、肝脏（24%）和肺（11%）。94%的复发患者在手术后 3 年内发生。单变量分析中与复发相关的因素为癌症分期、R1 切除、淋巴结转移、神经周围侵犯、微血管侵犯和淋巴管侵犯。多变量分析中与复发相关的因素为女性、静脉切除、进展的组织学分期和淋巴管侵犯。
接受胰十二指肠切除术治疗 dCCA 的患者中，有三分之二发生癌症复发，且大多数在手术后 3 年内复发。最常见的复发部位是胰腺床、肝脏和肺部。多个组织学特征与复发相关。
