WTP3.8 Histological stage and five-year outcomes in patients who undergo pancreatoduodenectomy for distal cholangiocarcinoma: an international multicentre study

Abstract Aims Patients with a distal cholangiocarcinoma (CC) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. Patients with early disease are known to have better outcomes. This study aimed to investigate and quantify the relationship between histological stage and five-year recurrence/survival. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre study of PD outcomes (29 centres in 8 countries, n=1484). CC patients were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test. Results A total of 205 patients (13.8%) had CC confirmed. The number of patients with T1, T2, T3 and T4 disease was 11 (5%), 25 (12%), 158 (78%), and 8 (4%), respectively (Tx: 3). Five-year recurrence was 9%, 32%, 70% and 75%, respectively. T1-2 patients (vs T3-4) had lower rates of five-year recurrence (OR: 0.1, 95% CI: 0.1-0.3). Five-year survival was 90%, 60%, 23% and 38% in patients with T1, T2, T3 and T4 disease, respectively. T1-2 patients (vs T3-4) had higher rates of five-year survival (OR: 5.8, 95% CI: 2.8-12.3). 69 patients (34%) had no lymph node involvement and 136 (66%) had positive regional lymph nodes. N0 patients (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.1-0.5) and higher five-year survival (OR: 4.5, 95% CI: 2.4-8.7) rates. Conclusions In our multicentre study of PD outcomes, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates in patients with CC.