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Vol. 17, No. 1, 2000
Issue release date: 2000
Dig Surg 2000;17:36–41

Adenocarcinoma of the Distal Bile Duct

A Clinicopathologic Outcome Analysis after Curative Resection

Bortolasi L. · Burgart L.J. · Tsiotos G.G. · Luque-de León E. · Sarr M.G.
Departments of aSurgery and bLaboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn., USA

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Background/Aims: Primary distal bile duct adenocarcinomas (DBDAs) are unusual neoplasms, necessitating pancreaticoduodenectomy for cure. The aims of this study were to evaluate the prognostic importance of lymphatic and perineural invasion, long-term outcome of patients after resection, and differences in outcome with hilar cholangiocarcinoma and pancreatic carcinoma. Methods: The medical records and histopathological slides of 15 patients (8 men and 7 women) with documented DBDA after curative pancreaticoduodenectomy were reviewed. Results: Nine standard and 6 pylorus-preserving pancreaticoduodenectomies were performed. TNM staging included 1, 3, 2, 8, and 1 patient in stages I, II, III, and IVA and IVB, respectively. Lymphatic and perineural invasion was present in 4 (27%) and 9 (60%) patients, respectively. With multivariate analysis only serum bilirubin was a significant prognostic factor. Median survival was 21 months, and 2- and 5-year actuarial survivals were 40 and 20%, respectively. Median survival with adjuvant therapy (n = 6) was 21 months, with 5-year survival of 33%. Five-year actuarial survivals when lymphatic or perineural invasion was present were 0 and 11%, respectively. Conclusion: DBDA is aggressive, but entails a better prognosis than pancreatic ductal or more proximal bile duct carcinoma. Lymphatic and/or perineural invasion worsen survival.

Copyright © 2000 S. Karger AG, Basel

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