Prognostic factors and patterns of recurrence after curative resection for patients with distal cholangiocarcinoma

Background and purpose: This study aimed to determine the prognostic factors and generate an atlas of a distribution of locoregional recurrence (LRR) in patients with distal cholangiocarcinoma (DCCA), after pancreatoduodenectomy (PD) without adjuvant radiotherapy.

Materials and methods: 124 DCCA cases registered in our institutional database from 2006 to 2018 were analyzed retrospectively. The Cox proportional hazards model was used for multivariable analysis. All recurrence sites were centrally reviewed, and LRRs were plotted on one CT scan of a template that represents the relapse pattern of the patients.

Results: The median follow-up time was 35.3 months (95% CI 22.1-48.5 months). Independent prognostic factor for locoregional recurrence-free survival was lymph node metastasis (p = 0.014). Older age, pancreas invasion, and lymph node metastasis were associated with poor survival (both p < 0.05). During the follow-up period, 69 patients (55.6%) developed disease progression. Among them, 45 patients (65.2%) had recurrence in the locoregional components. 21 patients (30.4%) were diagnosed with liver metastasis. Of the patients with LRR, most recurrences occurred in the nodes along the superior mesenteric artery (36.2%), nodes around the abdominal aorta (26.1%), nodes in the hepatoduodenal ligament (13.0%), nodes around the celiac artery (10.1%), and anastomotic stoma (10.1%).

Conclusion: The high-risk sites of LRR after PD for primary DCCA are the nodes along the superior mesenteric artery, abdominal aorta, nodes in the hepatoduodenal ligament, nodes around the celiac artery, and anastomotic stoma. Adjuvant radiation should cover these areas to improve locoregional control for these patients.