Postoperative outcomes and role of adjuvant therapy in common bile duct cancer

Polyakov AN, Patyutko YuI, Kotelnikov AG, et al. . Postoperative outcomes and role of adjuvant therapy in common bile duct cancer. Pirogov Russian Journal of Surgery. 2025;(12):69‑79. (In Russ., In Engl.)
https://doi.org/10.17116/hirurgia202512169

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To determine prognostic factors in resectable common bile duct (CBD) cancer and feasibility of adjuvant therapy.

MATERIAL AND METHODS

We retrospectively studied the results of pancreatoduodenectomy for CBD cancer in 1999—2023.

RESULTS

There were 89 patients, mortality rate was 5.6% (n=5), complications developed in 66 patients (74.2%), complications ≥ grade III — in 37 (41.7%) cases. Postoperative pancreatic fistula (POPF) grade B/C was detected in 29 (32.6%) cases. Postoperative chemotherapy was administered to 43 patients (gemcitabine-based therapy — 27, capecitabine alone — 15, capecitabine/oxaliplatin combination — 1). The median overall survival was 33 months, disease-free survival — 19 months. Among patients selected for assessment of long-term results (n=79), the median OS was 37 months, DFS — 30 months. Retroperitoneal invasion (RPI), pancreatic invasion (PI), perineural invasion (PNI), moderate/poor differentiation, R1 resection, retroperitoneal lymph node (LN) involvement worsened long-term results in multivariate analysis, regional LN involvement and elevated CA 19-9 — in univariate analysis. Accumulation of factors worsened prognosis. Postoperative chemotherapy improved OS (median OS 35 months vs. 16.5, p=0.035) in patients with two or more negative prognostic factors. Chemotherapy mode did not affect prognosis.

CONCLUSION

Retroperitoneal, pancreatic and perineural invasion, R1 resection, moderate/poor tumor differentiation, lymph node involvement and elevated CA 19-9 are negative prognostic factors in CBD cancer. Postoperative capecitabine monotherapy is justified in patients with two or more negative factors.

Keywords:

biliary cancer

extrahepatic cholangiocarcinoma

pancreatoduodenectomy

prognostic factors

postoperative chemotherapy

Authors:

Polyakov A.N.

Blokhin National Medical Research Center of Oncology

SPIN RSCI: 9924-0256
Scopus AuthorID: 57190413973
ORCID: 0000-0001-5348-5011

Patyutko Yu.I.

Blokhin National Medical Research Center of Oncology

RSCI AuthorID: 137980
Scopus AuthorID: 55666204300
ORCID: 0000-0001-9254-1346

Kotelnikov A.G.

Blokhin National Medical Cancer Research Center

ORCID: 0000-0002-2811-0549

Bazin I.S.

Blokhin National Cancer Research Center

ORCID: 0000-0003-2624-9341

Syskova A.Yu.

Blokhin National Cancer Research Center

SPIN RSCI: 1676-6072
Scopus AuthorID: 57205135357
ORCID: 0000-0001-7163-2089

Egenov O.A.

Blokhin National Medical Cancer Research Center

ORCID: 0000-0002-8681-7905

Komarov I.G.

Blokhin National Cancer Research Center

ORCID: 0000-0002-3495-5521

Podluzhnyi D.V.

Blokhin National Medical Cancer Research Center

ORCID: 0000-0001-7375-3378

Received:

12.01.2025

Accepted:

10.02.2025

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References:

Belkouz A, Van Roessel S, Strijker M, et al. Development and external validation of a prediction model for overall survival after resection of distal cholangiocarcinoma. Br J Cancer. 2022;126(9):1280-1288. https://doi.org/10.1038/s41416-021-01687-1
Bridgewater J, Fletcher P, Palmer DH, et al. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. J Clin Oncol. 2022;40(18):2048-2057. https://doi.org/10.1200/JCO.21.02568
Dominguez DA, Wong P, Chen YJ, et al. Adjuvant Chemoradiation in Resected Biliary Adenocarcinoma: Evaluation of SWOG S0809 with a Large National Database. Ann Surg Oncol. 2024;31(8):4896-4904. https://doi.org/10.1245/s10434-024-15117-y
Hester C, Nassour I, Adams-Huet B, et al. Improved Survival in Surgically Resected Distal Cholangiocarcinoma Treated with Adjuvant Therapy: a Propensity Score Matched Analysis. J Gastrointest Surg. 2018;22(12):2080-2087. https://doi.org/10.1007/s11605-018-3875-x
Komaya K, Ebata T, Fukami Y, et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol. 2016;51(6):608-619. https://doi.org/10.1007/s00535-015-1140-6
Zhou Y, Liu S, Wu L, Wan T. Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors. Asian J Surg. 2017;40(2):129-138. https://doi.org/10.1016/j.asjsur.2015.07.002
Komaya K, Ebata T, Shirai K, et al. Recurrence after resection with curative intent for distal cholangiocarcinoma. Br J Surg. 2017;104(4):426-433. https://doi.org/10.1002/bjs.10452
Kurahara H, Mataki Y, Idichi T, et al. Spread of lymph node metastasis and adjuvant therapy for distal cholangiocarcinoma. Int J Clin Oncol. 2022;27(7):1212-1221. https://doi.org/10.1007/s10147-022-02175-z
Yoshii H, Izumi H, Fujino R, et al. Subserosal Layer and/or Pancreatic Invasion Based on Anatomical Features as a Novel Prognostic Indicator in Patients with Distal Cholangiocarcinoma. Diagnostics (Basel). 2023;13(22):3406. Published 2023 Nov 9. https://doi.org/10.3390/diagnostics13223406
Min KW, Kim DH, Son BK, et al. Invasion Depth Measured in Millimeters is a Predictor of Survival in Patients with Distal Bile Duct Cancer: Decision Tree Approach. World J Surg. 2017;41(1):232-240. https://doi.org/10.1007/s00268-016-3687-7
Zhu Y, Zu G, Wu D, et al. Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of distal cholangiocarcinoma: A propensity score matching analysis. Front Oncol. 2022;12:1057337. Published 2022 Nov 18. https://doi.org/10.3389/fonc.2022.1057337
Lamarca A, Edeline J, McNamara MG, et al. Current standards and future perspectives in adjuvant treatment for biliary tract cancers. Cancer Treat Rev. 2020;84:101936. https://doi.org/10.1016/j.ctrv.2019.101936
Solodky VA, Kriger AG, Gorin DS, Dvukhzhilov MV, Akhaladze GG, Goncharov SV, Panteleev VI, Shuinova EA. Pancreaticoduodenectomy — results and prospects (two-center study). Pirogov Russian Journal of Surgery. 2023;(5):13-21. (In Russ.). https://doi.org/10.17116/hirurgia202305113
Kingham TP, Aveson VG, Wei AC, et al. Surgical management of biliary malignancy. Curr Probl Surg. 2021;58(2):100854. https://doi.org/10.1016/j.cpsurg.2020.100854
Chen Z, Yu B, Bai J, et al. The Impact of Intraoperative Frozen Section on Resection Margin Status and Survival of Patients Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma. Front Oncol. 2021;11:650585. Published 2021 May 03. https://doi.org/10.3389/fonc.2021.650585
Cloyd JM, Prakash L, Vauthey JN, et al. The role of preoperative therapy prior to pancreatoduodenectomy for distal cholangiocarcinoma. Am J Surg. 2019;218(1):145-150. https://doi.org/10.1016/j.amjsurg.2018.08.024
Li X, Lin H, Sun Y, Gong J, Feng H, Tu J. Prognostic Significance of the Lymph Node Ratio in Surgical Patients With Distal Cholangiocarcinoma. J Surg Res. 2019;236:2-11. https://doi.org/10.1016/j.jss.2018.10.044
Lyu S, Li L, Zhao X, Ren Z, Cao D, He Q. Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy. World J Surg Oncol. 2020;18(1):262. Published 2020 Oct 08. https://doi.org/10.1186/s12957-020-02040-1
Perez M, Hansen CP, Burdio F, et al. Lymph Node Ratio Nomogram-Based Prognostic Model for Resected Distal Cholangiocarcinoma. J Am Coll Surg. 2022;235(5):703-712. https://doi.org/10.1097/XCS.0000000000000299
Maeta T, Ebata T, Hayashi E, et al. Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma. Br J Surg. 2017;104(11): 1549-1557. https://doi.org/10.1002/bjs.10596
Yamamoto R, Sugiura T, Ashida R, et al. Vascular resection for distal cholangiocarcinoma. Surg Today. 2023;53(8):899-906. https://doi.org/10.1007/s00595-022-02634-0
Hassan H, Chakrabarti S, Zemla T, et al. Impact of perioperative chemotherapy on survival in patients with cholangiocarcinoma undergoing curative resection. Eur J Surg Oncol. 2023;49(11):106994. https://doi.org/10.1016/j.ejso.2023.106994
Edeline J, Benabdelghani M, Bertaut A, et al. Gemcitabine and Oxaliplatin Chemotherapy or Surveillance in Resected Biliary Tract Cancer (PRODIGE 12-ACCORD 18-UNICANCER GI): A Randomized Phase III Study. J Clin Oncol. 2019;37(8):658-667. https://doi.org/10.1200/JCO.18.00050
Ebata T, Hirano S, Konishi M, et al. Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J Surg. 2018;105(3):192-202. https://doi.org/10.1002/bjs.10776
Kobayashi S, Ikeda M, Nakachi K, Ueno M, Okusaka T, Todaka A, Satoi S, Tomokuni A, Konishi M, Furuse J. A Multicenter Survey on Eligibility for a Randomized Phase III Trial of Adjuvant Chemotherapy for Resected Biliary Tract Cancer (JCOG1202, ASCOT) [published correction appears in Ann Surg Oncol. 2023 Oct;30(11):6651. https://doi.org/10.1245/s10434-023-14026-w]. Ann Surg Oncol. 2023; 30(12):7331-7337. https://doi.org/10.1245/s10434-023-13913-6
Toyoda J, Sahara K, Takahashi T, et al. Neoadjuvant Therapy for Extrahepatic Biliary Tract Cancer: A Propensity Score-Matched Survival Analysis. J Clin Med. 2023;12(7):2654. Published 2023 Apr 02. https://doi.org/10.3390/jcm12072654
Jeong H, Kim KP, Jeong JH, et al. Adjuvant gemcitabine plus cisplatin versus capecitabine in node-positive extrahepatic cholangiocarcinoma: the STAMP randomized trial. Hepatology. 2023;77(5):1540-1549. https://doi.org/10.1097/HEP.0000000000000046