[Postoperative outcomes and role of adjuvant therapy in common bile duct cancer]

To determine prognostic factors in resectable common bile duct (CBD) cancer and feasibility of adjuvant therapy.

We retrospectively studied the results of pancreatoduodenectomy for CBD cancer in 1999-2023.

There were 89 patients, mortality rate was 5.6% (n=5), complications developed in 66 patients (74.2%), complications ≥ grade III - in 37 (41.7%) cases. Postoperative pancreatic fistula (POPF) grade B/C was detected in 29 (32.6%) cases. Postoperative chemotherapy was administered to 43 patients (gemcitabine-based therapy - 27, capecitabine alone - 15, capecitabine/oxaliplatin combination - 1). The median overall survival was 33 months, disease-free survival - 19 months. Among patients selected for assessment of long-term results (n=79), the median OS was 37 months, DFS - 30 months. Retroperitoneal invasion (RPI), pancreatic invasion (PI), perineural invasion (PNI), moderate/poor differentiation, R1 resection, retroperitoneal lymph node (LN) involvement worsened long-term results in multivariate analysis, regional LN involvement and elevated CA 19-9 - in univariate analysis. Accumulation of factors worsened prognosis. Postoperative chemotherapy improved OS (median OS 35 months vs. 16.5, p=0.035) in patients with two or more negative prognostic factors. Chemotherapy mode did not affect prognosis.

Retroperitoneal, pancreatic and perineural invasion, R1 resection, moderate/poor tumor differentiation, lymph node involvement and elevated CA 19-9 are negative prognostic factors in CBD cancer. Postoperative capecitabine monotherapy is justified in patients with two or more negative factors.