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Purpose <p>Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection.</p> Methods <p>We retrospectively reviewed 272 patients (1990–2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (<i>n</i> = 8) and a hepatectomy alone group (DMpos-HA, <i>n</i> = 10).</p> Results <p>A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 &gt; 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (<i>n</i> = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (<i>p</i> &lt; 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, <i>p</i> = 0.396), although the difference was not statistically significant. Major complications (Clavien–Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (<i>p</i> = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups.</p> Conclusion <p>In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.</p>

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Oncologic impact of additional pancreaticoduodenectomy for distal margin-positive perihilar cholangiocarcinoma: a multi-decade single-center analysis

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Koya Yasukawa,
  • Akira Shimizu,
  • Koji Kubota,
  • Tsuyoshi Notake,
  • Kiyotaka Hosoda,
  • Hiroki Sakai,
  • Hikaru Hayashi,
  • Yuji Soejima

摘要

Purpose

Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection.

Methods

We retrospectively reviewed 272 patients (1990–2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (n = 8) and a hepatectomy alone group (DMpos-HA, n = 10).

Results

A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 > 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (n = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (p < 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, p = 0.396), although the difference was not statistically significant. Major complications (Clavien–Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (p = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups.

Conclusion

In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.