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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Perioperative Outcome and Survival in Distal Bile Duct Adenocarcinoma – A Multicenter Retrospective Analysis

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  • Gabriel Seifert - Uniklinik Freiburg, Klinik für Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
  • Ulrich Friedrich Wellner - UKSH Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
  • Hryhoryi Lapshyn - Uniklinik Freiburg, Klinik für Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
  • Louisa Bolm - UKSH Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
  • Dirk Bausch - UKSH Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
  • Frank Makowiec - Uniklinik Freiburg, Klinik für Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
  • Ulrich Theodor Hopt - Uniklinik Freiburg, Klinik für Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
  • Tobias Keck - UKSH Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
  • Stefan Post - Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
  • Felix Rückert - Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland
  • Sebastian Zach - Universitätsmedizin Mannheim, Chirurgische Klinik, Mannheim, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch051

doi: 10.3205/15dgch051, urn:nbn:de:0183-15dgch0512

Published: April 24, 2015

© 2015 Seifert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: Distal dile duct adenocarcinoma (DBDAC) is rare and usually not diagnosed before resection. Data on perioperative outcome and survival is scarce. The aim of this study was retrospective analysis in a large patient cohort.

Material and methods: Retrospective exploratory data analysis was performed on the basis of prospectively maintained databases from three high-volume academic centers (University Hospitals of Mannheim, Freiburg and Lübeck, Germany) for hepatopancreatic surgery. Data collection and analysis was performed with MedCalc 14.8.1. software.

Results: From 1993 to 2013, n=111 patients (73 male, 38 female, median age 68 years) resected for DBDAC with perioperative and long-term follow-up could be identified. Operations performed were pylorus preserving pancreatoduodenectomy (PPPD, n=97), Whipple procedure (n=11) and total pancreatectomy (n=3), including 16 portal venous resections (PVR). Median operation time was 402 min, with 35% intraoperative blood transfusion requirement. Perioperative grade B/C (ISGPS definition) pancreatic fistula, delayed gastric emptying and postpancreatectomy hemorrhage and reoperation rates were 27%, 14%, 22% and 19%, respectively, with a perioperative mortality of 7%. Overall median and 5-year survival was 28 months and 29%. BMI, operation time, intraoperative transfusion, PVR, reoperation and surgical margin status were significant predictors of survival in univariate analysis. In a multivariate Cox proportional hazards model, preoperative CA19.9, surgical margin status, tumor grade and reoperation were independent predictors of survival.

Conclusion: DBDAC is a rare entity and associated with a high operative risk in terms of pancreatic fistula, bleeding and perioperative mortality. Survival figures after resection are relatively favorable and influenced by the surgical parameters resection margin status and reoperation rate, as well as the biologic factors tumor grading and CA19.9 level.

Figure 1 [Fig. 1]