Browsing by Author "Johansson, Alice"

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    Clinical outcome and survival for surgically resected distal cholangiocarcinoma in patients treated at Sahlgrenska University Hospital between 2010 – 2017
    (2021-08-05) Johansson, Alice; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    Introduction: While distal cholangiocarcinoma (DCC) constitutes its own entity, it is rarely studied as a separate case group and in lack of high-grade evidence regarding what the optimal treatment approach might be, it is often managed according to similar protocols as for pancreatic cancer (PC). Objective: To determine clinical outcome, survival and prognostic factors for surgically resected DCC compared to PC. Methods: This retrospective single centre cohort included 473 patients that were approved for pancreatic head surgery at Sahlgrenska University Hospital between 2010–2017. DCC constituted the case group, while PC formed the main controls. Results: DCC was histopathologically confirmed in 24 cases (5.1%), while the controls corresponded to 208 (44%). Severe postoperative complications were more likely to occur for DCC than for PC (p=0.002). The majority were later diagnosed with a recurrence (DCC 56.5% versus PC 78.7%; p=0.708) and the median cancer-free survival was 14 months for both groups, respectively. The risk of DCC recurrence was increased for tumour positive surgical margins (R1 84.6% versus R0 15.4%; p=0.013) and when no adjuvant chemotherapy was administered (84.6% versus 15.4%; p=0.039). Median overall survival was 16.5 months for DCC and 23 months for PC (p=0.733). Adjuvant chemotherapy had a beneficial impact on survival within the DCC group (p=0.001). Additionally, receiving adjuvant chemotherapy 5 with Gemcitabine, Capecitabine or GemCap provided a survival outcome in favour for DCC patients over the controls (p=0.005). Conclusion: DCC is a rare malignancy with poor prognosis for long-term survival. This could partly be explained by the high propensity for early non-curable recurrence, why extensive surgery and adjuvant chemotherapy seem to be of importance. Also, adjuvant chemotherapy seems to be more beneficial for DCC than for PC and could be a valuable addition owing to its advantageous impact on survival outcome and risk of recurrence.