Long-term Outcomes of Distal Cholangiocarcinoma (dCCA) Undergoing Pancreaticoduodenectomy (PD): A Single Centre Experience of 111 Patients

Introduction: Distal cholangiocarcinomas (dCCAs) are relatively rare compared to the other subtypes of cholangiocarcinoma as well as other periampullary tumors. dCCAs have aggressive clinical behaviour with surgical resection, through pancreaticoduodenectomy (PD), at the cornerstone of curative treatment. This study aims to investigate long-term outcomes and prognostic factors influencing survival post-PD in dCCA patients. Material and Methods: A retrospective analysis of dCCAs undergoing curative resection (PD) at Tata Memorial Centre, Mumbai, from April 2006 to November 2023 was performed. Clinical data, surgical details, complications, and follow-up were analysed. Long-term survival, and factors influencing survival were evaluated. Results: A total of 1810 patients underwent PD in the study period. 111 patients with dCCA were included. The median age of patients was 60 years, with male preponderance (67.57%). More than 90% of patients presented with obstructive jaundice with majority requiring preoperative biliary drainage (84.7%). Major complications were seen in 45 patients (40.54%) with five (4.5%) post-operative mortalities. The study reported a median overall survival (OS) of 39.3 months and a 5-year OS of 35.4%. Significant prognostic factors for OS included tumor differentiation, perineural invasion, resection margin, lymph node ratio (LNR) > 0.2, and the requirement of vascular resection. On multivariate analysis, vascular resection, positive resection margin, preoperative elevated CA 19.9 levels, and LNR > 0.2 were associated with inferior OS and disease-free survival (DFS). Conclusion: The aggressive nature of dCCAs necessitates comprehensive surgical and multidisciplinary management. Identified prognostic factors can guide clinical decision-making to improve patient outcomes.