Long-term survival of distal cholangiocarcinoma after pancreaticoduodenectomy combined with portal vein system resection and reconstruction
Authors: Lyu Shaocheng , Li Lixin , Zhao Xin , Ren Zhangyong , Cao Di , He Qiang 
Published: June 2020

Abstract
BACKGROUND:

Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. And the 5-year survival rate of distal cholangiocarcinoma after pancreatoduodenectomy ranged from 22–47%. Pancreatoduodenectomy combined with portal vein system resection and reconstruction for distal cholangiocarcinoma is rarely reported because it’s not common. To our knowledge, only few reports have provided the detail outcome and long-term survival of distal cholangiocarcinoma after pancreaticoduodenectomy combined with portal vein system resection and reconstruction. Therefore, we developed a program to analysis the risk factors of prognosis for distal cholangiocarcinoma patients after pancreaticoduodenectomy, and to evaluate the vascular invasion type, operation procedure and long-term survival of patients with portal vein system invasion.
METHODS:

Retrospective reviewed for 123 distal cholangiocarcinoma patients after pancreatoduodenectomy between January 2011 and December 2019. Portal vein system invasion in 17 patients according to the pathology. Multivariable regression Cox models produced survival estimate to the distal cholangiocarcinoma patients. Then patients were grouped according to portal vein system invasion, and tumor-free and overall survival rates were investigated with the Kaplan-Meier analysis. Finally, the vascular invasion type and operation procedure were analyzed to the distal cholangiocarcinoma patients with portal vein system invasion.
RESULTS:

The 1-year, 3-year, 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, 31.5%. Multifactor Cox regression showed tumour differentiation degree (RR = 1.440, 95%CI:1.009–2.055), portal vein system invasion (RR = 1.860, 95%CI:1.057–3.275) and lymph node metastasis (RR = 2.097, 95%CI: 1.054–4.174) as independent risk factors for long-term survival. There were 17 patients underwent pancreatoduodenectomy combined with portal vein system resection and reconstruction. The patients with portal vein system invasion had larger tumor diameter, longer operation time, more blood transfusion rate and more lymph node metastasis rate than control group (P < 0.05). The 1-year, 2-year overall survival rates for patients without and with portal vein system invasion were 79.7%, 58.9% and 48.6%, 10.8% (p = 0.000). The median overall survival time for patients without and with portal vein system invasion were 49.1 and 14.2 months, respectively.
CONCLUSION:

The portal vein system invasion is an important independent risk factors for long-term survival to the patients with distal cholangiocarcinoma, and the long-term survival is poor. Pancreatoduodenectomy combined with portal vein system resection and reconstruction did not increase the incidence of perioperative complication rate and mortality. At present, surgery maybe still the only effective method for distal cholangiocarcinoma patients with portal vein system invasion.